Intramedullary Nailing of Paediatric Tibial Fractures: Comparison between Flexible and Rigid Nails

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Traumatology

Background:

• Intramedullary nailing is a common surgical technique for treating pediatric tibial fractures.
• Both flexible (elastic stable) and rigid intramedullary nails are used, each with potential advantages and disadvantages.

Purpose of the Study:

• To compare the patient characteristics and clinical outcomes of children with tibial fractures treated with rigid intramedullary nailing versus elastic intramedullary nailing.
• To evaluate the effectiveness of different intramedullary nailing techniques in achieving acceptable alignment and minimizing complications.

Main Methods:

• Retrospective review of 56 pediatric patients (26 flexible nailing, 30 rigid nailing) treated between 2008 and 2017.
• Analysis of demographic data, preoperative and postoperative radiographs (6-12 weeks and final follow-up), and complication rates.

Main Results:

• A higher proportion of patients treated with flexible nails had open proximal tibial physes (100% vs. 46.7%).
• Rigid nailing resulted in significantly better postoperative alignment (96.7% vs. 76.9%) and no malunions, compared to flexible nailing (23% malunion rate).
• Complication rates were similar between the two groups (15% flexible vs. 23% rigid).

Conclusions:

• Rigid intramedullary nailing is superior for achieving acceptable alignment and preventing malunion in pediatric tibial fractures.
• Elastic stable intramedullary nailing may be suitable for younger children with open proximal tibial physes, while rigid nailing is recommended for more mature adolescents.