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A Prospective Analysis of Physeal-Sparing Intramedullary Interlocking Nail for Adolescent Tibial Shaft Fractures
Prakash Shah1, Lakhan Singh Maravi1, Ashish Sirsikar1
1Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Introduction:
Management of tibial shaft fractures in adolescents with open physes remains challenging because stable fixation must be achieved without compromising physeal integrity. This study evaluated the clinical, radiological, and functional outcomes of physeal-sparing intramedullary interlocking nailing in adolescent tibial shaft fractures.
Material And Methods:
A prospective descriptive interventional cohort study was conducted in the Department of Orthopaedics at a tertiary care teaching hospital between May 2024 and April 2026. Twenty-six adolescents aged 13-17 years with tibial shaft fractures and open physes underwent physeal-sparing intramedullary interlocking nailing. Patients were assessed using Visual Analog Scale (VAS) for pain, tibial fracture healing score (TFHS) for functional outcome, and radiographic union scale for tibial fractures (RUST) for radiological healing. Follow-up evaluations were performed at 2, 6, 12, and 24 weeks postoperatively.
Results:
The mean age was 15.23 ± 1.18 years, and 76.9% of patients were male. Road traffic accidents accounted for 69.2% of injuries. Closed fractures constituted 76.9% of cases, while 53.8% were AO/OTA type 42-A fractures. Median VAS pain scores improved from 5.0 at 2 weeks to 0.0 at 12 and 24 weeks. Median TFHS total score improved from 2.50 at 6 weeks to 1.00 at 24 weeks. Mean RUST scores increased significantly from 5.08 ± 0.74 at 6 weeks to 8.42 ± 0.99 at 12 weeks and 11.54 ± 0.58 at 24 weeks (P < 0.001). Radiographic union was achieved in 26.9% of patients at 12 weeks and in 100% by 24 weeks, with a mean union time of 14.23 ± 2.23 weeks. Complications included superficial infection (3.8%), anterior knee pain (7.7%), and delayed union (7.7%), with no cases of deep infection, nonunion, malunion, implant failure, or growth disturbance.
Conclusion:
Physeal-sparing intramedullary interlocking nailing provides reliable fracture union, excellent functional recovery, and a low complication rate in adolescents with tibial shaft fractures while preserving physeal integrity.
