Problems of operative and non-operative treatment and healing in tibial fractures

Based on the experience of the department of pediatric surgery at the Strasbourg University Hospital, the authors present indications and limitations of various treatment techniques for tibial shaft fractures in children. Two retrospective series are reported on: one group of patients treated with the Sarmiento technique and one group of patients treated with Elastic Stable Intramedullary Nailing (ESIN or Métaizeau technique). The main problem in treatment is restoration of the mechanical axis of the tibia, especially in isolated fractures treated conservatively. Residual varus deformity is frequent, although it is usually within an acceptable range. ESIN has given better results than conservative treatment in this specific case, but valgus malunion shave been noticed when both bones were fractured, due to insufficient bending of the medial nail. ESIN is perfectly suited for treating polytrauma patients,especially those with multi level or open fractures (Gustilo 1 or 2), as it makes monitoring and nursing easier. Treatment of tibia fractures in children remains principally conservative. ESIN is indicated in cases of failure of conservative treatment, especially in isolated tibia fractures or polytrauma patients. For high grade open fractures (Gustilo 3)or extended comminuted fractures, external fixation remains the gold standard.