Elastic stable intramedullary nailing for fractures in children – specific applications

Cosma, Dan; Vasilescu, Dan

doi:10.15386/cjmed-275

Cited by 9 publications

(11 citation statements)

References 16 publications

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“…There has been an increasing trend towards operative management of long-bone shaft fractures 7,70 in recent decades. Diaphyseal fractures are characterized by limited potential for remodeling and spontaneous correction because of the distance from the physis 17 , which may justify more aggressive surgical treatment. There are also changes is patients' requests, economic circumstances, living habits and sports, which may have contributed to a change against surgical fixation 17 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…At present, elastic stable intramedullary nailing (ESIN) is the gold-standard method of surgical treatment of forearm shaft fractures [13][14][15][16] . Compared with open reduction and plate fixation, ESIN is less traumatic and results in better cosmesis 17,18 . It shows an equally good union rate and is also feasible when open reduction is needed 1,19,20 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

et al. 2018

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

et al. 2018

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“…[29][30][31][32][33][34][35] In two studies, 36,37 distal tibia fractures were no distinguishable from diaphyseal fractures, and two studies 38,39 reported only the incidence of compartment syndrome. Three additional studies reporting only epidemiological data, 40 surgical technique, 41 and long-term outcomes, 42 respectively, were excluded.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Stenroos

Puhakka

Nietosvaara³

et al. 2019

Eur J Pediatr Surg

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Tibia fractures are among the most common long-bone fractures in children. Despite this, there is no current consensus on the optimal treatment strategy for closed displaced tibia shaft fractures in the pediatric patient population. The aim of this study is to compare the reported complications and outcomes of reduction and cast immobilization versus flexible intramedullary nailing in the treatment of pediatric tibia shaft fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this prospectively registered systematic review. Eleven studies were included. Quality of the studies was assessed using the Coleman methodology score. Mantel–Haenszel cumulative odds ratios were used to compare the risk of complication between different methods of treatment. Eleven studies including 1,083 patients with diaphyseal fractures of the tibia met the inclusion criteria. The most common fracture type was simple 42-A (782; 91%). Majority (75%) of the patients were treated nonoperatively. The total complication rate was higher among operatively treated patients (24 vs. 9%; p < 0.05). Satisfactory fracture alignment had to be restored surgically in 5% of the primarily nonoperatively treated patients. The evidence levels of the included studies were II (1), III (2), and IV (7). Three-fourths of closed diaphyseal fractures of the tibia in children are still treated with reduction and cast immobilization. Flexible intramedullary nailing is associated with significantly higher complication rate than nonoperative treatment.

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“…The use of elastic stable intramedullary nails has almost become a routine treatment method for pediatric diaphyseal fractures of long bones in the last few years. There is much evidence that proves this method has the benefits of early immediate stability to the involved bone segment, which permits early mobilization and return to normal activities of the patients without immobilization, with very low complication rates [ 13 , 14 , 15 , 16 ]. The benefits of ESIN, compared to other surgical techniques, include shorter surgical time, minimal soft-tissue dissection, improved cosmesis, less pain, early mobilization, and relatively easy implant removal [ 13 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is much evidence that proves this method has the benefits of early immediate stability to the involved bone segment, which permits early mobilization and return to normal activities of the patients without immobilization, with very low complication rates [ 13 , 14 , 15 , 16 ]. The benefits of ESIN, compared to other surgical techniques, include shorter surgical time, minimal soft-tissue dissection, improved cosmesis, less pain, early mobilization, and relatively easy implant removal [ 13 , 14 , 15 , 16 ]. Although many authors recommend immobilization in the postoperative period, our previous study clearly showed that immobilization is not necessary and that there is no increased number of complications if immobilization did not occur [ 13 , 15 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

Pogorelić

Vegan²,

Jukić³

et al. 2022

Children

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Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for tibial fractures. Methods: The study included 132 patients (92 males) with a median age of 11 years (IQR 10, 15) treated with ESIN for displaced tibial shaft fractures or dia-metaphyseal distal tibial fractures from March 2002 to March 2022. The median follow-up was 118.5 months (IQR 74.5, 170). The primary outcome was success rate, while secondary outcomes were the time of bone healing, length of hospital stay, and associated injuries. Demographic data, type and nature of fracture, indication for surgery, healing time, operative time, complications of treatment, and time to implant removal were recorded. Results: Complete radiographic healing was achieved at a median of 7 weeks (IQR 6, 9). Most of the patients (n = 111; 84.1%) had fractures localized in the shaft of the tibia. The most common injuries were acquired by road traffic accidents (n = 42) and by a fall in the same level (n = 29), followed by injuries from sport activities (n = 21) or motorbike accidents (n = 18). Associated injuries were reported in 37 (28%) children. Fractures were closed in the majority of the children (n = 100; 76%), while 32 (24%) children presented with an open fracture. Children with open fractures were significantly older than children with closed fractures (13.5 years (IQR 10, 15) vs. 11 years (IQR 8.5, 14.5); p = 0.031). Furthermore, children with open fractures had a significantly longer hospital stay (7 days (IQR 5, 9) vs. 3 days (IQR 3, 6); p = 0.001), a higher rate of associated injuries (n = 14 (43.7%) vs. n = 23 (23%); p = 0.022), and a higher rate of postoperative complications (n = 7 (21.9%) vs. n = 8 (8%); p = 0.031). No intraoperative complications were recorded. A total of 15 (11.4%) postoperative complications were recorded. Most complications (60%) were minor complications, mostly related to the wound at the nail insertion site and were managed conservatively. A total of six (4.5%) patients required reoperation due to angulation of the fragments (n = 5) or refracture (n = 1). Conclusion: ESIN is a minimally invasive bone surgery technique and is a highly effective treatment for pediatric tibial unstable fractures with a low rate of complications. Based on the given results, surgical stabilization of the tibial fractures using titanium intramedullary nailing can be safely performed without casting with early physiotherapy.

show abstract

Elastic stable intramedullary nailing for fractures in children – specific applications

Cited by 9 publications

References 16 publications

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

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