Abstract
Introduction
The treatment of open and unstable metaphyseo-diaphyseal fractures of the tibia in adolescents is challenging. It is important to choose a fixation method that can maintain alignment, allow wound care and not violate the growth plate. The aim of this work was to evaluate the efficacy of using flexible intramedullary nails (FIN) augmented by external fixator (EF) in the management of such fractures.
Patients and methods
A total of 26 males, with a mean age of 14.08 years and average body weight of 49.8 kg, presented with open metaphyseo-diaphyseal tibial fractures. All cases were treated using FIN augmented by mono-lateral EF. The fractures were located at the upper third in 17 cases and at the lower third in nine cases. The fracture pattern was spiral in eight cases, oblique in seven and multi-fragmentary in 11. The results were evaluated according to the scoring system for femoral TENs.
Results
All fractures united primarily after an average eight to 12 weeks with no evident angular deformity or limb-length discrepancy. None of the cases required cast immobilization or revision procedure. Twenty patients had excellent results, six patients showed good results and none had poor results. Fracture characteristics as well as patients' characteristics had no statistically significant effect (p > 0.005) on the final end results.
Conclusions
The use of FIN augmented by EF is a good alternative in the management of open metaphyseo-diaphyseal tibial fractures in adolescents. This fixation provides more stability, allows easy access to the wound and early patients’ ambulation.
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References
Cullen MC, Roy DR, Crawford AH (1996) Open fracture of the tibia in children. J Bone Joint Surg Am 78:1039–1047
Court-Brown CM, Byrnes T, McLaughlin G (2003) Intramedullary nailing of tibial diaphyseal fractures in adolescents with open physes. Injury 34:781
Gad HF, Abul Kheir IH, Booz MK (1990) Closed nailing of tibial shaft fractures. Injury 21(4):217–219
Grimard G, Naudie D, Laberge LC, Hamdy RC (1996) Open fractures of the tibia in children. Clin Orthop Relat Res 332:62–70
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J (2001) Titanium elastic nails for pediatric femur fractures––a multicenter study of early results with analysis of the aim complications. J Pediatr Orthop 21(1):4–8
Huber RI, Keller HW, Huber PM, Rehm KE (1996) Flexible intramedullary nailing as fracture treatment in children. J Pediatr Orthop 16:602–605
Qidawi SA (2001) Intramedullary Kirschner wiring for tibia fractures in children. J Pediatr Orthop 21:294–297
Barry M, Paterson JM (2004) Flexible intramedullary nails for fractures in children. J Bone Joint Surg (Br) 86-B:947–953
Vrsansky P, Bourdelat D, Faour A (2000) Flexible stable intramedullary pinning technique in the treatment of pediatric fractures. J Pediatr Orthop 20:23–27
Wiss D, Segal D, Gumbs VL, Salter D (1986) Flexible nailing of tibial shaft fractures. J Trauma 62(12):1106–1112
Nirav K, Eric W (2012) Immediate intramedullary flexible nailing of open pediatric tibial shaft fractures. J Pediatr Orthop 32(8):770–776
Tolo VT (1983) External skeletal fixation in children’s fractures. J Pediatr Orthop 3:435–442
Gordon JE, Gregush RV, Schoenecker PL, Dobbs MB, Luhmann SJ (2007) Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop 27(4):442–446
Awais S, Saeed A, Ch A (2014) Use of external fixators for damage-control orthopaedics in natural disasters like the 2005 Pakistan earthquake. Int Orthop 38(8):1563–1568
Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H (2014) Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. Int Orthop. 2014 Dec 5. [Epub ahead of print]
Kubiak EN, Egol KA, Scher D (2005) Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am 87:176
Sun LJ, Wu ZP, Guo XS, Chen H (2014) Management of distal third tibial fractures: comparison of combined internal and external fixation with minimally invasive percutaneous plate osteosynthesis. Int Orthop 38(11):2349–2355
O’Brien T, Weisman DS, Ronchetti P, Piller CP, Maloney M (2004) Flexible titanium nailing for the treatment of the unstable pediatric tibial fracture. J Pediatr Orthop 24:601–609
Hussain R, Umar M (2001) Treatment of tibial diaphyseal fractures with closed flexible intramedullary ender nails: fractures followed for a period of two to seven years. JPMA 51:190
Berger P, Graaf JS, Leemans R (2005) The use of elastic intramedullary nailing in the stabilization of paediatric fractures. Injury 36:1217–1220
Vallamshetla VRP, De Silva U, Bache CE, Gibbons PJ (2006) Flexible intramedullary nails for unstable fractures of the tibia in children. J Bone Joint Surg (Br) 88(4):536–540
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Atef, A., El Tantawy, A. Open unstable metaphyseo-diaphyseal fractures of the tibia in adolescents: treatment by flexible intramedullary nails augmented by external fixator. International Orthopaedics (SICOT) 39, 921–926 (2015). https://doi.org/10.1007/s00264-015-2700-3
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DOI: https://doi.org/10.1007/s00264-015-2700-3