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Treatment of Unstable Tibia Shaft Fractures in Children With Elastic Stable Intramedullary Nails or Minimally
Michał Maciejewski1,2, Jan Klincewicz1, Piotr Janusz2
1Department of Pediatric Orthopedics and Traumatology, Mother and Child Care Center.
Insights
Minimally invasive plate osteosynthesis (MIPO) shows promise for severe pediatric tibial shaft fractures, offering better stabilization than elastic-stable intramedullary nailing (ESIN) without casting, despite longer surgery times.
Area of Science:
- Pediatric Orthopedics
- Surgical Innovation
- Fracture Management
Background:
- Tibial shaft fractures are common in children, requiring management tailored to fracture type, child's weight, and growth plate status.
- Elastic-stable intramedullary nailing (ESIN) is the standard surgical approach for pediatric tibial fractures with open physes.
- Alternative surgical techniques may be necessary for complex cases.
Purpose of the Study:
- To compare outcomes of tibial shaft fractures in children treated with ESIN versus minimally invasive plate osteosynthesis (MIPO).
- To evaluate the efficacy and complication rates of MIPO compared to ESIN in pediatric tibial fractures.
Main Methods:
- A retrospective study of 59 children with unstable tibial shaft fractures treated between 2018-2023 (27 MIPO, 32 ESIN).
- Data collected included demographics, fracture type, surgery duration, complications, bone healing, tibial axis, and implant position.
- Functional outcomes assessed using the EFAS Questionnaire at a mean follow-up of 3.7 years.
Main Results:
- All patients achieved bone union; MIPO had a lower complication rate (7.4% vs. 15.6%) and no reoperations compared to ESIN (12.5%).
- MIPO surgery duration was significantly longer (79.0 min vs. 41.8 min for ESIN).
- No significant differences were found in final tibial axis or EFAS scores between the groups.
Conclusions:
- Minimally invasive plate osteosynthesis (MIPO) is a viable alternative for severe, unstable pediatric tibial shaft fractures.
- MIPO offers superior stabilization without the need for post-operative casting.
- While MIPO involves longer operative times, it demonstrates a promising safety and efficacy profile.
Introduction:
Tibial shaft fractures are common fractures in children. The optimal management should be selected based on the fracture type, the child's weight, and the presence of open growth plates. When surgical treatment is indicated, elastic-stable intramedullary nailing (ESIN) is considered the generally preferred method in children with open physes. However, in some cases, alternative treatment may be required.
Aim:
The aim of this study was to compare the outcomes of tibial shaft fractures in children treated with ESIN versus minimally invasive plate osteosynthesis (MIPO).
Methods:
Fifty-nine children were treated for unstable tibial shaft fractures between 2018 and 2023 (27 with MIPO and 32 with ESIN). Patients' demographics, fracture type, surgery duration, and complications were recorded based on medical records. Bone healing, tibial axis, and implant position were assessed on follow-up radiographs. Functional outcomes were evaluated using the EFAS Questionnaire at 3.7±1.8 years (range: 1.0 to 6.8) after surgery.
Results:
Bone union was achieved in all patients. The total complication rate was 7.4% in the MIPO group and 15.6% in the ESIN group ( P =0.4365). No reoperations were required in the MIPO group, while 12.5% of patients in the ESIN group required reoperation ( P =0.1176). A plaster cast was applied in 46.9% of ESIN patients and in none of the MIPO patients. The surgery duration was significantly longer in the MIPO group (79.0 vs. 41.8 min in the ESIN group; P =0.0001). There was no significant difference in the final tibial axis at the final follow-up (2 ESIN patients underwent reoperation for axis correction). There was no significant difference in EFAS Questionnaire scores: 38.1±2.1 in the MIPO group versus 36.5±3.9 in the ESIN group ( P =0.1235).
Conclusions:
Minimally invasive plate osteosynthesis is a promising alternative to elastic-stable intramedullary nails in the most severe, unstable tibial shaft fractures. Plating provides better stabilization without the need for a plaster cast; however, surgery time is longer.
Level Of Evidence:
Level III.
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