Purpose Tibial fractures in the skeletally immature patient are usually treated without surgery. Elastic stable intramedullary nailing (ESIN) is commonly used for other diaphyseal fracture locations. Its advantages are minimally invasive surgery with a short hospitalisation duration, primary bone union and early weight bearing. The purpose of this study was to assess the use of ESIN in displaced tibial fractures in children over 6 years old and in cases of polytrauma. Methods This study was carried out over a 6-year period. The protocol consisted in ESIN of shaft tibial fractures in children over 6. Frontal and sagittal angulation, shortening and lengthening were measured on days 0, 2, 15, 30 and 45. At 6 months, 1 and 2 years, the femoro-tibial axis and eventual shortening or lengthening were assessed. ResultsThe study involved 86 children (average age 11.8 years). As early as day 30, all patients had normal knee mobility and symmetrical foot progress angle. At 2-year follow-up, frontal angulation and leg length discrepancy had decreased and affected 2% of patients. Four patients (5%) suffered from superficial infections. There were no cases of osteomyelitis or refracture. Conclusions The fixation of paediatric diaphyseal tibial fractures with ESIN is a rapid, well-codified and effective method for treating long-bone closed fractures in children. Advantages over other fixation techniques include a lower infection rate, a lower refracture rate, ease of management, and an aesthetically pleasing scar.

Talus bipartitus is an exceptional congenital malformation consisting in the presence of two non-fused bony talar fragments. We report the case of an adolescent girl who complained of mechanical pain in the left ankle which became increasingly invalidating. Plain radiographs, CT-scan and MRI led to the diagnosis of this congenital anomaly: talus bipartitus. Surgical correction by subtalar arthrodesis provided improvement at the cost of reduced ankle mobility. Surgical treatment should be proposed for talus bipartitus in patients with invalidating pain or stiffness when rehabilitation fails to provide sufficient improvement.

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