Complications After Titanium Elastic Nailing of Pediatric Tibial Fractures

Abstract

A retrospective review of 60 diaphyseal tibia fractures (31 closed and 29 open fractures) treated with flexible intramedullary fixation was conducted. All charts and radiographs were reviewed. Children ranged in age from 5.1 to 17 years. Fifty patients with 51 fractures were followed up until union and comprised the study group. The mean follow-up period for these 50 patients was 79 weeks. Forty-five fractures achieved bony union within 18 weeks (mean, 8 weeks). Five patients (11%) had delayed healing (3 had delayed unions that ultimately healed with casting or observation, and 2 had nonunions that required secondary procedures to achieve union [1 patient underwent a fibular osteotomy, and 1 underwent exchange nailing with a reamed tibial nail]). These 5 fractures ultimately healed, with a mean time to union of 41 weeks. Patients with delayed healing tended to be older (mean age, 14.1 years) versus the study population as a whole (mean age, 11.7 years). In addition to delayed union, other complications were observed in the study population. One patient healed with malunion (13-degree valgus), requiring corrective osteotomy. One patient with a grade II open fracture was diagnosed with osteomyelitis at the fracture site after attaining bony union. Two patients developed nail migration through the skin, requiring modification or nail removal. The fixation of pediatric diaphyseal tibia fractures with titanium elastic nails is effective but has a substantial rate of delayed healing, particularly in older patients.

Elastic stable intramedullary nailing of tibial shaft fractures in children

“…We had only one patient under the age of six who sustained polytrauma with a floating knee. Moreover, the fracture types in our study population were similar to those described in the literature [10,14,16,21]. Our study on 86 young patients confirms the efficiency of this technique in the immediate treatment of tibial shaft fractures.…”

“…Gicquel [14] reported a frequency of 20% of infections among his patients; he also described deep infections for Gustilo 2 open fractures. Furthermore, in Gordon's series [21], one patient with a Gustilo grade 2 open fracture was diagnosed with osteomyelitis at the fracture site after attaining bone union. We did not have this complication because the Gustilo 2 and 3 open fractures were not treated by this method [20].…”

“…This delay is shorter than that described in the literature. In a retrospective review of 60 diaphyseal tibial fractures treated with flexible intramedullary fixation, Gordon [21] achieved 45 bone unions within 18 weeks (average 8 weeks). Furthermore, in their series five patients (11%) had delayed healing, among which 2 required secondary procedures to obtain union (with a mean time to union of 41 weeks).…”

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

“…Recently, flexible intramedullary nailing has become the preferred method for the treatment of tibial shaft fractures that require operative fixation [6,[8][9][10][11][12][13].…”

Osteossíntese das fraturas diafisárias da criança com hastes intramedulares flexíveis

“…Os resultados ruins são pouco freqüentes e relacionados com encurtamento angulação e má rotação (31) ; os desvios rotacionais não sofrem remodelação com o tempo. Embora pacientes mais velhos (~14 anos) tenham maior tendência para apresentar problemas de consolidação, poucas vezes há indicação de tratamento operatório (32)(33) . Entretanto, alguns casos requerem estabilização cirúrgica, como no paciente politraumatizado, com trauma craniencefálico, lesões de pele tipo abrasão, queimaduras e síndrome de compartimento.…”