Elastic Stable Intramedullary Nailing of Tibial Shaft Fractures in Children

Srivastava, Adarsh; Mehlman, Charles T.; Wall, Eric J.; Twee, T.

doi:10.1097/bpo.0b013e318165210d

Cited by 89 publications

(90 citation statements)

References 29 publications

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“…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.…”

Section: Discussionsupporting

confidence: 75%

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Elastic stable intramedullary nailing of tibial shaft fractures in children

Griffet

Leroux

Boudjouraf

et al. 2011

Journal of Children's Orthopaedics

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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.

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Section: Discussionsupporting

confidence: 75%

“…Clinical results are good, whichever treatment method is chosen [3,5,7,[13][14][15][16]. Closed reduction and casting is the mainstay of treatment for diaphyseal tibial fractures [2].…”

Section: Discussionmentioning

confidence: 99%

Elastic stable intramedullary nailing of tibial shaft fractures in children

Griffet

Leroux

Boudjouraf

et al. 2011

Journal of Children's Orthopaedics

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…Studies looking specifically at flexible nailing of tibia fractures have cited rates of CS as high as 32.0%, yet it is unclear from these studies if CS occurred before or after flexible nailing had been performed [8,11,21,22]. Although the risk of CS after flexible nailing of forearm fractures has been noted to be as high as 10.0% [23], there has not been a specific study in the literature examining the risk for CS after flexible nailing of tibia fractures.…”

Section: Introductionmentioning

confidence: 99%

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

Pandya¹,

Edmonds

Mubarak

2011

Journal of Children's Orthopaedics

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Purpose Pediatric tibial shaft fractures are common injuries encountered by the orthopaedic surgeon. Flexible intramedullary nailing has become popular for pediatric patients with tibial shaft fractures that require operative fixation. The purpose of our study was to evaluate the incidence of, and the risk factors for, compartment syndrome (CS) after flexible intramedullary nailing of these injuries. Methods A retrospective review of tibial shaft fractures treated consecutively with flexible intramedullary nailing at our institution from 2003 to 2010 was performed. The incidence of CS after flexible nailing was recorded. In addition, age, weight, mechanism of injury, polytrauma, presence of an open fracture, presenting neurovascular exam, fracture pattern, delay in treatment ([24 h from injury), prior closed reduction attempts, method of reduction (open vs. closed) in the operating room, total fluoroscopy time, and operative time were recorded. Comparisons were made between children who developed CS and those who did not. Results Thirty-one children met inclusion criteria with a mean age of 11.2 years (range, 6.3-15.3 years); all were boys. Nearly, 20% of children developed CS after flexible nailing of their fractures. Those who developed CS after flexible nailing were heavier than the unaffected group (52.6 ± 14.5 kg vs. 39.4 ± 15.2 kg, P = 0.05); with a greater percentage of children 50 kg or greater (83.3% vs. 26.1%, P = 0.02) within the CS group. Children who developed CS were also more likely to present with neurologic deficits in the absence of compartmental swelling prior to surgery (66.7% vs. 9.1%, P = 0.009), and more likely to have comminuted/complex fracture patterns (83.3% vs. 29.1%, P = 0.02). There was no difference between patients who did and did not develop CS in regards to age (P = 0.42), high-energy injury mechanism (P = 0.30), polytrauma (P = 1.0), delay in treatment (P = 0.28), prior closed reduction attempts (P = 1.0), method of reduction (open vs. closed; P = 1.0) in the operating room, total fluoroscopy time (P = 0.96), and total operative time (P = 0.45). In addition, there was no difference (P = 0.65) in the rates of CS between children with open and closed fractures. Conclusions There is a high risk of CS after flexible intramedullary nailing of pediatric tibial shaft fractures regardless of whether an injury is open or closed. Variables that would seemingly be associated with the development of CS (high-energy injury mechanisms, polytrauma, treatment delay, prior closed reduction attempts, and closed reduction in the operating room) were not statistically associated with CS in our study. Clinicians should be wary for the development of CS whenever utilizing flexible nails for tibial shaft fractures, especially when the following co-morbidities are present: the child weighs greater than 50 kg, has complex/comminuted fracture patterns, or has a neurologic deficit in the absence of compartmental swelling prior to operative intervention.

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“…Nonetheless, in adolescence they can already be used with the same criteria as for adults. Srivastava et al 18 studied 24 high-energy trauma fractures in 24 children. The mean age was 11 years, ranging from 4.6 to 16.4 years.…”

Section: Diaphyseal Fracturesmentioning

confidence: 99%

Fraturas da diáfise da tíbia em crianças

Santili¹,

Gomes²,

Akkari³

et al. 2010

Acta ortop. bras.

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Tibial diaphyseal fractures in children and adolescents are relatively common injuries and often evolve with good results when treated through traditional methods of conservative treatment. Their elevated frequency is due to the high degree of exposure of children in physical activities and also to the topographic location, exposing them to direct or indirect trauma. The approach used should consider and respect some features regarding age, place of affection (whether proximal or distal), type of fracture and therapy. The anatomical advantage of a thicker periosteum and flexibility when submitted to angular impacts can provide younger children with greater stability and, consequently, increases their chances of a better prognosis than older children and adolescents. In the latter, the degree of exposure to highenergy trauma and the greater complexity and severity of injuries have caused the recent trend towards stabilization surgery to become more common. Frequent complications in the evolution of fractures in adults such as infection, delayed union and nonunion are much less common in children, although the risk of occurrence of compartment syndrome is an event that requires attention, especially with plaster.

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Elastic Stable Intramedullary Nailing of Tibial Shaft Fractures in Children

Cited by 89 publications

References 29 publications

Elastic stable intramedullary nailing of tibial shaft fractures in children

Elastic stable intramedullary nailing of tibial shaft fractures in children

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

Fraturas da diáfise da tíbia em crianças

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