Elastic nailing of tibia shaft fractures in young children up to 10 years of age

Heo, Jeong; Oh, Chang-Wug; Kim, Joon‐Woo; Kim, Hee-June; Lee, Jong‐Chul; Park, Il-Hyung

doi:10.1016/j.injury.2015.10.024

Cited by 32 publications

(31 citation statements)

References 17 publications

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“…Surgical treatment can be performed with different fixation methods such as intramedullary fixation, crossed Kirschner wires (K-wires), or external fixators. External fixators are the first-line treatment in fractures with severe soft-tissue loss, although they have been associated with several complications such as delayed union, malunion, high incidence of pin tract infections, and leg-length inequality [1,2,3,4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Uludağ

Tosun

2019

Medicina

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Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3–14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6–20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

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Section: Introductionmentioning

confidence: 99%

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Uludağ

Tosun

2019

Medicina

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“…The amount of weight-bearing is self-evaluated by the patients themselves according to the pain that it produces. The average union time in our study was 10.2 weeks (13.3 weeks, Onta PR et al [18], 11 weeks Sanker WN et al [10], 16 weeks Heo J et al [19]) with closed and open fractures healing at an average of 9.4 and 12.2 weeks respectively. Most of the studies have shown irritation at the nail entry site as the most common complication following ESIN in the femur, ranging in incidence from 7 to 40%.…”

Section: Studymentioning

confidence: 50%

“…Many previous studies have supported the use of elastic nails in femur fractures in children [11][12][13]. However, few small series have described the use of elastic intramedullary nails for pediatric tibial shaft fractures [8][9][10][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Titanium Elastic Intramedullary Nailing in Paediatric Tibial Shaft Fractures

Byanjankar¹,

Shrestha²,

Sharma³

et al. 2018

Orthop Muscular Syst

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Introduction: Most of the pediatric tibial shaft fractures are treated non-operatively with close reduction and casting. Surgical indications include unstable fractures, open fracture, polytrauma patients, compartment syndrome or severe soft tissue injury. The purpose of this study was to assess the outcome of tibial shaft fracture fixation with titanium elastic intramedullary nails. Patients and methods: The average age of the patient was 11.3 years (range 6 to 15 years) and mean follow up was 14 months (range 6 to 26 months). Patient's charts and radiographs were reviewed retrospectively. The outcomes were classified as excellent, satisfactory or poor according to Flynn's criteria for flexible nail fixation. Results: All patients achieved union at a mean of 10.3 weeks (8 to 14 weeks). Full weight bearing was achieved at a mean of 9.2 weeks (8 to 14 weeks). At last follow-up, the result was excellent in 18 patients and satisfactory in 4 patients. Nineteen patients had less than 5-degree angulation and three patients had 5-10 degree angulation. The most common complication was irritation at nail entry site. Two cases had superficial wound infection at entry site and both healed with oral antibiotics and dressing changes. Summary: Elastic intramedullary nailing is a safe and reliable treatment method for pediatric tibial fractures. It provides stable fixation and allows rapid healing of fractures with minimal complications.

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“…44,45 Immediate flexible nailing of open paediatric tibial shaft fractures can be safely performed with minimal risk of wound or infectious complications. 47,48 However, the risk of compartment syndrome is high regardless of whether a child has a closed or open tibia fracture and upmost care should be taken in performing flexible nailing in patients who may have closed head injury due to a risk of systemic complications. 49 Although external fixation in open paediatric tibial fractures is recommended, intramedullary nailing is also an effective method with low complications.…”

Section: Discussionmentioning

confidence: 99%

Safe leg surgery: the anatomic principles and techniques

Kumar

Babu

2020

Int Surg J

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The goals of surgical treatment of leg injury are to achieve soft tissue healing, good osseous union and to restore the length of the limb, correct alignment of both bones with their respective joints and normal range of movements of the entire limb at the earliest. Presently, the surgical treatment has been standardised for the tibia fractures for adults and children. Though the surgical progress made in the implants, instruments and techniques, there are considerable surgical complications happening. This article highlights the need of anatomical expertise and safe operative ability for the surgeon.

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Elastic nailing of tibia shaft fractures in young children up to 10 years of age

Cited by 32 publications

References 17 publications

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Titanium Elastic Intramedullary Nailing in Paediatric Tibial Shaft Fractures

Safe leg surgery: the anatomic principles and techniques

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