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Treatment of open pediatric tibial fractures by external fixation versus flexible intramedullary nailing: a
Hossein Aslani1, Ali Tabrizi2, Ali Sadighi3
1Pediatric Orthopedic, Tehran University of Medical Sciences,Tehran, IR Iran.
Insights
Flexible intramedullary nailing and external fixation are effective for pediatric open tibial fractures, with similar union times. Combining flexible intramedullary nails with pins offers enhanced stability without increased complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Fracture Management
Background:
- Tibial fractures are common in children, with distal third fractures being most prevalent.
- High-energy tibial fractures in children require careful treatment to prevent long-term complications.
- Open pediatric tibial fractures pose significant treatment challenges due to high-energy mechanisms.
Purpose of the Study:
- To compare the efficacy and complication rates of external fixation versus flexible intramedullary nailing for open pediatric tibial fractures.
- To evaluate treatment outcomes including infection, union, mal-union, and re-fracture.
- To assess the effectiveness of combined pin and flexible intramedullary nail techniques.
Main Methods:
- A descriptive analytical study involving 32 pediatric patients with open tibial fractures.
- Patients were treated with either external fixators (n=18) or titanium elastic nails (TEN) (n=14).
- Outcomes were assessed over a two-year follow-up, focusing on union, complications, and stability.
Main Results:
- No significant difference in fracture union time was observed between external fixation (12.5 weeks) and TEN (11.8 weeks).
- External fixation had higher complication rates, including pin site infection (22.2%) and re-fracture (22.2%).
- Titanium elastic nailing resulted in fewer complications, primarily painful bursitis (14.2%), with no mal-union requiring correction.
Conclusions:
- Flexible intramedullary nailing is an effective treatment for open pediatric tibial fractures with a low complication profile.
- External fixation, while recommended for severe injuries, presents a higher risk of complications.
- Combining pins with flexible intramedullary nails provides superior stability without increasing adverse events.
Background:
Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibial fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases.
Objectives:
In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the open pediatric tibial fractures.
Materials And Methods:
In this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n = 18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years.
Results:
Mean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails.
Conclusions:
Although external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.
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