Flexible Titanium Nailing for the Treatment of the Unstable Pediatric Tibial Fracture

O’Brien, Todd; Weisman, David; Ronchetti, Peter J.; Piller, Christopher P; Maloney, Michael D.

doi:10.1097/01241398-200411000-00001

Cited by 86 publications

(64 citation statements)

References 15 publications

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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%

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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“…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%

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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“…14,15 There are few articles in the literature on the management of diaphyseal fractures of the tibia in children with intramedullary fixation. 11,16,17 O'Brien et al reported 16 fractures of the tibia, fixed internally with intramedullary fixation, which achieved a very good functional outcome. 17 They reported one superficial infection, six coronal and seven sagittal angulations, but no functional compromise.…”

Section: Discussionmentioning

confidence: 99%

“…11,16,17 O'Brien et al reported 16 fractures of the tibia, fixed internally with intramedullary fixation, which achieved a very good functional outcome. 17 They reported one superficial infection, six coronal and seven sagittal angulations, but no functional compromise. One child had a leg-length discrepancy of over 1.5 cm.…”

Section: Discussionmentioning

confidence: 99%

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

Gurung

Khatri

2016

J Lumbini Med Coll

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ABSTRACT:Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks (SD=2.65) for close and 14.3 weeks (SD=2.62) for open fracture. There were no instances of growth arrest, re-manipulations, or re-fracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

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“…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) .…”

Section: Introductionunclassified

“…São feitos a introdução e o avanço da outra haste, obedecendo aos princípios de posicionamento já descritos para o fê-mur. A fratura é impactada, o comprimento das hastes é ajustado, são cortadas a 1cm do osso, impactadas e sepultadas, de modo a não fazer saliência, mas não tão profundamente que dificulte a ulterior retirada (31) . O paciente usa gesso curto e a carga é autorizada quando a radiografia mostra a formação de calo ósseo (~5 semanas).…”

Section: Introductionunclassified

Osteossíntese das fraturas diafisárias da criança com hastes intramedulares flexíveis

Volpon¹

2008

Rev. bras. ortop.

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Flexible Titanium Nailing for the Treatment of the Unstable Pediatric Tibial Fracture

Cited by 86 publications

References 15 publications

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

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

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

Osteossíntese das fraturas diafisárias da criança com hastes intramedulares flexíveis

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