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Titanium Elastic Nailing for Pediatric Tibia Fractures: Do Older, Heavier Kids Do Worse?
Christine M Goodbody1, Rushyuan J Lee, John M Flynn
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Titanium elastic nails are safe for pediatric tibial fractures, regardless of patient age or weight. This study found no significant differences in malunion rates or healing times for heavier or older children.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Biomaterials Science
Background:
- Elastic nailing is a standard fixation for pediatric tibial shaft fractures.
- Concerns exist regarding titanium elastic nail (TEN) use in heavier or older pediatric patients, based on adverse outcomes in femoral fractures.
- This study investigates age and weight limits for TEN in tibial fractures.
Purpose of the Study:
- To determine if patient age or weight influences the safety and efficacy of titanium elastic nails for pediatric tibial shaft fractures.
- To identify potential upper limits for patient age and weight in TEN fixation of tibial fractures.
Main Methods:
- Retrospective cohort study of 95 pediatric patients with tibial shaft fractures treated with TEN.
- Patients were stratified by weight (≥50 kg vs. <50 kg) and age (≥14 years vs. <14 years).
- Outcomes assessed included malunion (≥10° angulation) and time to union (≥3 cortices bridged).
Main Results:
- No significant difference in malunion rates between weight groups (13.3% vs. 10%, P=0.61) or age groups (17.6% vs. 8.2%, P=0.17).
- Time to union was comparable across all age and weight cohorts.
- Mean patient age was 12.1 years; mean weight was 50.2 kg.
Conclusions:
- Titanium elastic nails are a safe and effective fixation method for pediatric tibial shaft fractures across a wide range of patient ages and weights.
- Unlike other long bone fractures, age and weight do not appear to be contraindications for TEN use in pediatric tibial fractures.
Background:
Elastic nailing is a common method of fixation for tibial shaft fractures in skeletally immature individuals. Poor outcomes of titanium elastic nails for femoral shaft fractures have been associated with increasing patient age and weight, especially patients weighing >50 kg. Our objective is to determine if there is an upper weight or age limit to the safe and effective use of titanium elastic nails for tibial shaft fractures in the pediatric population.
Methods:
This is a retrospective cohort study of patients who underwent stabilization of a tibial shaft fracture with titanium elastic nails at a large tertiary-care pediatric trauma center. Data collected included patient demographics, injury characteristics, and radiographic data. Weight groups were stratified as ≥ or <50 kg, and age groups as 14 years or older or less than 14 years old. Malunion was defined as 10 degrees of angulation in either the sagittal or coronal plane. Union was defined as bridging of ≥3 cortices on orthogonal radiographs. A significant difference in time to union was considered to be 3 weeks.
Results:
Ninety-five patients were included with a mean age of 12.1 years (range, 6 to 16 y) and a mean weight of 50.2 kg (range, 21 to 122 kg). Malunion rate was similar between weight cohorts: 13.3% (6/45) in the ≥50-kg group and 10% (5/50) in the <50-kg group (P=0.61). Malunion rate was similarly comparable between age groups: 17.6% (6/34) in the 14 years and older group and 8.2% (5/61) in the less than 14-year-old group (P=0.17). There was no statistically significant difference in time to union between weight or age cohorts. In sum, we did not find a significant difference in the rate of malunion or time to healing between younger and older patients or between lighter and heavier patients.
Conclusion:
The use of titanium elastic nails for tibial shaft fractures, unlike for other long bone fractures, seems not to be precluded in older and heavier patients.
Level Of Evidence:
Level III.
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