Operative Treatment of Tibial Fractures in Children: Are Elastic Stable Intramedullary Nails an Improvement Over External Fixation?

Kubiak, Erik N.; Egol, Kenneth A.; Scher, David M.; Wasserman, Bradley R.; Feldman, David S.; Koval, Kenneth J.

doi:10.2106/jbjs.c.01616

Cited by 81 publications

(113 citation statements)

References 31 publications

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“…In addition, patients with concomitant lower extremity fractures can be mobilized more rapidly because of the increased ability to weight bear through the extremity. The surgical technique is straightforward and is familiar to most pediatric orthopedists due to its widespread use in the treatment of other fractures in children [18,[21][22][23][24][25][26][27]. Surgical stabilization of humeral shaft fractures in children, when indicated, can be safely performed using titanium elastic nails.…”

Section: Resultsmentioning

confidence: 99%

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Garg

Dobbs

Schoenecker

et al. 2009

Journal of Children's Orthopaedics

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Background Nearly all pediatric humeral shaft fractures can be successfully treated with closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. Methods This is a retrospective review of all traumatic humeral shaft fractures treated at our hospitals between 1999 and 2006. Thirteen pediatric patients ranging in age from 4.8 to 16.7 years (mean age 12.0 years) were treated surgically with titanium elastic nails (TENs). Relative surgical indications included open fractures, inability to maintain an acceptable reduction, the presence of ipsilateral forearm fractures (floating elbow), concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Results The patients were followed for a mean of 29 months. All fractures healed in good alignment. There were no intraoperative complications, including neurologic or vascular injury, and no patient developed an infection postoperatively. Two patients had nail migration, one of whom developed nail protrusion through the skin. One patient with preoperative radial nerve injury ultimately underwent tendon transfer to restore wrist extension. Of the 13 patients, 12 reported a full return to sports and other activities with no limitations or discomfort. Conclusions When surgical stabilization of pediatric humeral shaft fractures is indicated, TEN fixation is effective and has a high rate of union and a low rate of complications. This technique is familiar to most orthopaedic surgeons treating pediatric fractures. Level of evidence Level of evidence: IV (case series)

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Section: Resultsmentioning

confidence: 99%

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Garg

Dobbs

Schoenecker

et al. 2009

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%

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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“…Conservative treatment with a spica cast with or without traction produces a satisfactory outcome in patients younger than 6 years of age 5,11,12,13,14,15 . Primary indications for surgical treatment include polytrauma, severe head injury, open fractures, multiple long bone fractures and ipsliateral tibia fractures 16,17,18 .…”

Section: Discussionmentioning

confidence: 99%

Role of Enders Nail In Diaphyseal Fractures of Long Bones in Pediatric Age Group

Gupta¹

2013

IOSR-JDMS

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Operative Treatment of Tibial Fractures in Children: Are Elastic Stable Intramedullary Nails an Improvement Over External Fixation?

Abstract: When surgical stabilization of tibial fractures in children is indicated, we believe that the preferred method of fixation is with elastic stable intramedullary nailing.

Cited by 81 publications

References 31 publications

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

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

Role of Enders Nail In Diaphyseal Fractures of Long Bones in Pediatric Age Group

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