Outcomes using titanium elastic nails for open and closed pediatric tibia fractures
Insights
Titanium elastic nails effectively treat pediatric tibial fractures. However, open fractures show longer healing times, more procedures, and extended hospital stays compared to closed fractures.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
Background:
- Titanium elastic nailing is a common surgical technique for pediatric tibial fractures.
- Assessing outcomes for closed versus open fractures is crucial for treatment planning.
Purpose of the Study:
- To compare the outcomes of closed and open pediatric tibial fractures treated with titanium elastic nails.
- To evaluate the efficacy and complication rates of this treatment modality in different fracture types.
Main Methods:
- Retrospective review of 38 pediatric patients treated with titanium elastic nails for tibial fractures over 5 years.
- Data collected included fracture type (closed vs. open), Gustilo-Anderson classification, time to union, complications, and hospital stay.
- Statistical analysis compared outcomes between closed and open fracture groups.
Main Results:
- Open fractures had a significantly longer mean time to union (9 months) compared to closed fractures (4 months).
- Delayed union was more frequent in open fractures (52%) versus closed fractures (6%).
- Open fractures required more surgical procedures and resulted in longer hospital stays.
Conclusions:
- Titanium elastic nailing is a viable treatment for both closed and open pediatric tibial shaft fractures.
- Open fractures present greater challenges, including prolonged healing and increased resource utilization.
Abstract:
The authors conducted a retrospective review at their level I trauma center to assess the outcomes of closed vs open pediatric tibial fractures treated with titanium elastic nails. The study group included 38 pediatric patients (median age, 12 years) treated with titanium elastic nails for tibial fractures during a 5-year period. Patient demographics, closed or open injury, Gustilo-Anderson type for open fractures, fracture location, skeletal maturity, time to union, hospital length of stay, number of procedures performed per patient, and complications were recorded. The main outcome measures were time to union and complications. Average follow-up duration was 13 months. Mean time to union was 4 months for closed and 9 months for open fractures (P<.001). Average time to union for type IIIA and IIIB fractures was significantly increased (11 and 12 months, respectively; P=.02). Delayed union (>6 months postoperatively) occurred in 1 (6%) of 17 closed fractures compared with 11 (52%) of 21 open fractures. The average number of surgical procedures for closed fractures was fewer than for open fractures (2 vs 3 procedures, respectively; P=.03). Mean hospital length of stay was shorter for closed than open fractures (3 vs 6 days, respectively; P=.03). Two infections occurred in the open fracture group. Closed and open pediatric tibial shaft fractures can be successfully treated with titanium elastic nails. Open fractures treated with titanium elastic nails have a significantly longer time to union, require additional operative procedures, and result in longer hospital stays.
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