Abstract
Purpose: Elastic stable intramedullary nailing (ESIN) and open reduction internal fixation (ORIF) are literature-supported operative treatments for displaced tibial shaft fractures in skeletally immature patients. Very little is written about rigid intramedullary nails (RIMNs) in adolescents. Our purpose is to describe a physeal-sparing, reamed, locked RIMN technique for adolescent tibial shaft fractures and report its safety.Methods: Adolescent patients with tibial shaft fractures indicated for operative intervention at one institution were retrospectively identified from 2011-2018. Patients were classified based on method of fracture fixation. Primary outcomes included fracture union, reoperation, and complication rates.Results: Thirteen patients were included in the RIMN arm, with an average age of 13.8 years. Two patients in the observational group underwent ESIN and seven patients underwent ORIF, with an average age of 11.5 years. Significant differences were found between time of immobilization (28 days vs 121 days), time to touch down weight bearing release (1 day vs 34 days), and hardware pain (2/13 vs 7/9). The RIMN group sustained fewer reoperations (2/13 vs 5/9). No differences were found in rates of complications or fixation failure between groups.Conclusions: Based on our small pilot study, RIMNs in adolescents should be considered as a potential treatment option when a physeal-sparing distal start point is utilized. Additionally, short-term follow-up suggests safety. Patients who underwent the RIMN procedure required fewer reoperations compared with the observational group. Overall, fracture healing was similar across the two groups. The benefits of RIMN include early immobilization and improved weight-bearing profile.Level of Evidence: IV.
Highlights
This article was previously presented as a meeting abstract at the 2019 South Carolina Orthopedic Association Annual Meeting in August 2019 and at the 2020 Southern Orthopaedic Association Annual Meeting in July 2020
Thirteen patients were included in our experimental rigid intramedullary nails (RIMNs) arm, all of them male ranging in ages 13-17 at time of surgery
Significant differences were found between time of immobilization (121 days vs 28 days; p
Summary
This article was previously presented as a meeting abstract at the 2019 South Carolina Orthopedic Association Annual Meeting in August 2019 and at the 2020 Southern Orthopaedic Association Annual Meeting in July 2020. Tibial shaft fractures are among the most common pediatric fractures, making up approximately 15% of long bone fractures in this population. They are both the third most common pediatric fracture in general and the third most common fracture in a multiply injured pediatric patient [1]. Unstable tibial shaft fractures have historically been treated with elastic stable intramedullary nailing (ESIN), external fixation, or open reduction internal fixation (ORIF) with plates and screws. Complications associated with these include pin site infection, nonunion, overgrowth, and refracture [2,3,4]
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