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Suprapatellar Tibial Nailing in Skeletally Immature Patients: A Case Series
Mckenzie D Brandt1, Michael S Barnum2, Jose A Herrera-Soto3
1Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, United States.
Insights
Suprapatellar rigid intramedullary nailing (RIMN) for pediatric tibial shaft fractures showed no signs of growth arrest. This technique offers a safe and effective option, allowing for a faster return to weight-bearing activities and sports.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Skeletal Growth Research
Background:
- Tibial shaft fractures are common in children.
- Rigid intramedullary nails (RIMN) are used for adult fractures but safety in skeletally immature patients with open physes is debated.
- Growing evidence supports RIMN for pediatric tibial fractures due to stability and early weight-bearing.
Purpose of the Study:
- To evaluate the safety and utility of suprapatellar RIMN fixation for tibial shaft fractures in skeletally immature children.
- To assess for iatrogenic growth arrest and other post-operative complications.
- To determine the time to union, full weight-bearing, and return to sport.
Main Methods:
- Retrospective case series of seven skeletally immature patients.
- Patients treated with suprapatellar RIMN fixation for tibial shaft fractures.
- Follow-up focused on clinical signs of growth arrest, complications, union, and return to activity.
Main Results:
- No clinical evidence of iatrogenic growth arrest or limb deformity observed.
- Mean time to union was 24.17 weeks.
- Average return to full weight-bearing and sport was 10.33 and 22.67 weeks, respectively.
- One infection and one delayed union case occurred; most patients did not require hardware removal.
Conclusions:
- Suprapatellar RIMN fixation is a safe and effective treatment for tibial shaft fractures in skeletally immature children.
- The technique is not associated with iatrogenic growth arrest.
- It facilitates an expedited return to weight-bearing activities and sports.
Introduction:
Tibial shaft fractures are common pediatric injuries. Rigid intramedullary nails (RIMN) are widely used for the fixation of complex tibial shaft fractures in skeletally mature individuals, but their safety is debated in patients with open physes. There has been growing support for the use of RIMN fixation in pediatric patients due to the stability and rapid return to weight-bearing activities they offer. In this study, we evaluate the utility and safety of suprapatellar RIMN fixation in skeletally immature children with tibial shaft fractures.
Materials And Methods:
This retrospective case series includes seven skeletally immature patients treated with suprapatellar RIMN fixation of tibial shaft fractures at a single level one trauma center between May 1, 2009, and May 1, 2024. The primary outcome of interest was clinical signs of iatrogenic growth arrest. Secondary outcomes of interest included post-operative complications and time to full weight bearing (FWB), union, and sport.
Results:
The mean age at the time of operation was 13.7 years (range: 12-15) and the mean follow-up time was 14.21 months (range: 6-26.5). We observed no clinical evidence of iatrogenic growth arrest or limb deformity post-operatively. The mean time to union was 24.17 weeks. On average, patients returned to FWB and full activity/sport at 10.33 and 22.67 weeks, respectively. The majority of patients (n = 5) did not require hardware removal with the exception of one patient who developed a deep tissue infection and another with delayed union of an associated fibula fracture.
Conclusion:
In a series of seven skeletally immature children, suprapatellar RIMN fixation of tibial shaft fractures was not associated with iatrogenic growth arrest. Benefits of this fixation technique include an expedited return to weight-bearing activity and sport.
