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Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children
Kaiying Shen1, Haiqing Cai, Zhigang Wang
1Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Elastic stable intramedullary nailing (ESIN) effectively treats severe pediatric distal tibial fractures. This minimally invasive method shows high healing rates and good functional outcomes with few complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Elastic stable intramedullary nailing (ESIN) is a recognized osteosynthesis technique for pediatric diaphyseal fractures.
- Severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures present unique challenges in pediatric patients.
Purpose of the Study:
- To evaluate the preliminary clinical and radiographic outcomes of ESIN for severely displaced DTDMJ fractures in skeletally immature individuals.
- To assess complication rates associated with ESIN in this specific fracture pattern.
Main Methods:
- A 6-year retrospective study of 21 pediatric patients with severely displaced DTDMJ fractures treated with ESIN.
- Clinical and radiographic evaluations were performed, focusing on healing, function, and complications like nonunion, malunion, infection, growth disturbance, and implant irritation.
Main Results:
- 19 out of 21 fractures demonstrated clinical and radiographic healing within 5 months.
- All patients achieved full range of motion in the knee and ankle.
- Minor complications occurred in 5 patients, including leg length discrepancy (2), delayed union (2), and hallux joint stiffness (1). No growth arrest was observed.
Conclusions:
- ESIN is a safe and effective treatment of choice for pediatric severely displaced DTDMJ fractures not amenable to closed reduction or casting.
- The technique offers advantages such as accelerated fracture healing, excellent functional and cosmetic results, and a low rate of severe complications.
Abstract:
Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in the skeletally immature patient for many advantages, the purpose of this study is to evaluate the preliminary results of this minimally invasive treatment for severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures.This study was carried out over a 6-year period. Twenty-one severely displaced DTDMJ fractures treated using ESIN were evaluated clinically and radiographically. Complications were assessed: the patients were evaluated with regard to nonunion, malunion, infection, growth arrest, leg length discrepancy, implant irritation, and joint function.Mean age at the time of surgery was 7.8 years (range between 5.3 and 14.8 years), mean body weight 34.1 kg, all fractures were transverse or mild oblique type, including 3 open fractures, 5 multifragmented fractures, and 4 fractures associated with polytrauma; 6 cases were treated with antegrade ESIN of tibia while 15 cases need combined retrograde fibula and antegrade tibia fixation treatments. Follow-ups were ranging from 11 to 36 months, 19 fractures showed both clinical and radiographic evidence of healing within 5 months; all cases had full range motion of knee and ankle with symmetrical foot progress angle. Nail removal was at a mean 7.1 months, at final follow-up, no growth arrest or disturbances occurred. Five patients had complications; leg length discrepancy had decreased yet affected 2 patients, 2 cases showed delayed union, and 1 case developed restricted dorsal extension at the metatarsophalangeal joint of the hallux.ESIN is the treatment of choice for pediatric severely displaced DTDMJ fractures that cannot be reduced by closed reduction or ones that cannot be casted. The advantages include faster fracture healing, excellent functional and cosmetic results, safe and reliable surgical technique, and lower severe complication rate.
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