Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails
<i>Background and objectives</i>: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of...
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-06-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1010-660X/55/6/266 |
| _version_ | 1827847426865627136 |
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| author | Abuzer Uludağ Hacı Bayram Tosun |
| author_facet | Abuzer Uludağ Hacı Bayram Tosun |
| author_sort | Abuzer Uludağ |
| collection | DOAJ |
| description | <i>Background and objectives</i>: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. <i>Materials and methods</i>: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3−14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. <i>Results</i>: The mean time to union was 10.85 ± 3.39 (range of 6−20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (<i>p</i> < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. <i>Conclusions</i>: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound. |
| first_indexed | 2024-03-12T09:31:20Z |
| format | Article |
| id | doaj.art-98022a58898040ea911da32448d08151 |
| institution | Directory Open Access Journal |
| issn | 1010-660X |
| language | English |
| last_indexed | 2024-03-12T09:31:20Z |
| publishDate | 2019-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-98022a58898040ea911da32448d081512023-09-02T13:54:20ZengMDPI AGMedicina1010-660X2019-06-0155626610.3390/medicina55060266medicina55060266Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic NailsAbuzer Uludağ0Hacı Bayram Tosun1Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100 Adiyaman, TurkeyDepartment of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100 Adiyaman, Turkey<i>Background and objectives</i>: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. <i>Materials and methods</i>: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3−14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. <i>Results</i>: The mean time to union was 10.85 ± 3.39 (range of 6−20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (<i>p</i> < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. <i>Conclusions</i>: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.https://www.mdpi.com/1010-660X/55/6/266pediatricfracturetibiaelastic intramedullary nail |
| spellingShingle | Abuzer Uludağ Hacı Bayram Tosun Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails Medicina pediatric fracture tibia elastic intramedullary nail |
| title | Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails |
| title_full | Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails |
| title_fullStr | Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails |
| title_full_unstemmed | Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails |
| title_short | Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails |
| title_sort | treatment of unstable pediatric tibial shaft fractures with titanium elastic nails |
| topic | pediatric fracture tibia elastic intramedullary nail |
| url | https://www.mdpi.com/1010-660X/55/6/266 |
| work_keys_str_mv | AT abuzeruludag treatmentofunstablepediatrictibialshaftfractureswithtitaniumelasticnails AT hacıbayramtosun treatmentofunstablepediatrictibialshaftfractureswithtitaniumelasticnails |