Intramedullary wiring for tibial shaft fractures in children before epiphyseal closure

Summary

Between 1958 and 1987 36 children underwent intramedullary wiring for tibial shaft fractures. Of these, 29 presented with combined tibial and fibular fractures, and 7 showed isolated tibial shaft fractures. Fractures were simple in 22 and compound in 14 patients. Mean patient age was 13 years (4–16 years). Only bending fractures with and without splinters were wired. The wiring technique and the protocol for postoperative care are reviewed. Mean immobilization time in long-leg casts was 12 weeks; intramedullary wires were removed after a mean interval of 17.7 weeks. Patients were selected for intramedullary wiring because of compound fractures of variable severity (14 patients), brain injuries with associated fractures (1), relative separation of the fracture ends with the fibula intact (2), severe dislocation or expected instability following closed reduction (9), and secondary dislocation or unsatisfactory alignment on skeletal traction (9). Complications included infections of 2nd degree compound fractures (2 patients), transitory peroneal palsy (2) and delayed union (2). Non-union and damage related to immobilization were not seen. A total of 19 patients were available for follow-up. Mean follow-up time was 9 years. Posttreatment lateral displacement was found to be irreversible except in infants but had no functional relevance. Malalignment showed a tendency towards spontaneous correction, which decreased with increasing age. Correction surgery proved to be unnecessary. Differential longitudinal growth was not consistently evaluable because of the heterogeneity of the material; reported data on this parameter from the literature were equally inconclusive. The experience prompted a modification of the strategy used: leg shortening is only accepted in infants and in patients with soft-tissue problems; in all other cases primary correction of leg length is attempted