Pediatric and Adolescent Tibial Shaft Fractures: Flexible Nail, Rigid Nail, Plate, or External Fixation

Tibial shaft fractures are common injuries in children and may occur as a result of trauma, sports-related activity, or falls. Casting has historically been considered the gold standard form of treatment; however, the inherent risks associated with casting, such as malunion and prolonged immobilization, have led to a rise in surgical techniques to treat these injuries. Minimally invasive, elastic stable intramedullary nailing is commonly used, whereas rigid intramedullary nailing is better suited for older children. Patients with complex fractures and severe soft-tissue injury or bone loss are treated with external fixation, whereas plate fixation is reserved for specific fracture patterns not amenable to intramedullary fixation. There is ongoing debate regarding the ideal pediatric and adolescent tibial shaft fracture management algorithm. It is important to assess changing treatment paradigms, comparing the surgical stabilization options and making evidence-based recommendations tempered by the authors' experience.