Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients

Area of Science:

• Orthopaedic Surgery
• Pediatric Orthopaedics
• Trauma Surgery

Background:

• Skeletally immature patients with tibial fractures require careful treatment considerations.
• Rigid intramedullary nailing (RIMN) is a surgical option, but concerns exist regarding physeal injury and tibial slope changes.
• Understanding outcomes in this population is crucial for optimizing fracture management.

Purpose of the Study:

• To evaluate the outcomes of tibial RIMN in skeletally immature patients.
• To specifically assess for postoperative complications and iatrogenic changes in tibial slope.
• To determine the safety and efficacy of RIMN in this patient group.

Main Methods:

• Retrospective case series of skeletally immature patients (within 2 years of maturity) undergoing tibial RIMN for OTA/AO 42 A-C fractures.
• Analysis of postoperative radiographs to assess tibial slope changes.
• Evaluation of complications, weight-bearing status, and return to activity.

Main Results:

• No significant change in tibial slope was observed post-RIMN (80.0° pre-op vs. 80.1° post-op).
• Average time to full weight-bearing was 45.4 days.
• Low complication rates: 14% hardware removal, 89% returned to normal activity.

Conclusions:

• Tibial RIMN is a safe and effective treatment for skeletally immature patients with tibial shaft fractures nearing skeletal maturity.
• The procedure is not associated with iatrogenic physeal injury or significant tibial slope alterations.
• Early weight-bearing and high rates of return to activity support RIMN as a viable option, with caution advised for younger patients.