Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis

doi:10.1007/s00402-021-03839-7

Review

. 2022 Jul;142(7):1469-1482.

doi: 10.1007/s00402-021-03839-7. Epub 2021 Feb 26.

Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis

Daniele Fanelli^#¹, Gerardo Perrotta^#², Fabio Stocco^#³, Joshua Agilinko⁴, Davide Castioni⁵, Michele Mercurio⁶, Giorgio Gasparini⁶, Simon Barker⁷

Affiliations

¹ Department of Trauma and Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, UK.
² GI Surgery Department, University College London Hospitals NHS Foundation Trust, London, UK.
³ Division of Surgery and Anaesthetics, Huddersfield Royal Infirmary, Huddersfield, UK.
⁴ Department of General Surgery, North Middlesex University Hospital, London, UK.
⁵ Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy. davide.n.castioni@gmail.com.
⁶ Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy.
⁷ Royal Aberdeen Children's Hospital, Aberdeen, UK.

^# Contributed equally.

PMID: 33635402
DOI: 10.1007/s00402-021-03839-7

Review

Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis

Daniele Fanelli et al. Arch Orthop Trauma Surg. 2022 Jul.

. 2022 Jul;142(7):1469-1482.

doi: 10.1007/s00402-021-03839-7. Epub 2021 Feb 26.

Authors

Daniele Fanelli^#¹, Gerardo Perrotta^#², Fabio Stocco^#³, Joshua Agilinko⁴, Davide Castioni⁵, Michele Mercurio⁶, Giorgio Gasparini⁶, Simon Barker⁷

Affiliations

¹ Department of Trauma and Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, UK.
² GI Surgery Department, University College London Hospitals NHS Foundation Trust, London, UK.
³ Division of Surgery and Anaesthetics, Huddersfield Royal Infirmary, Huddersfield, UK.
⁴ Department of General Surgery, North Middlesex University Hospital, London, UK.
⁵ Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy. davide.n.castioni@gmail.com.
⁶ Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy.
⁷ Royal Aberdeen Children's Hospital, Aberdeen, UK.

^# Contributed equally.

PMID: 33635402
DOI: 10.1007/s00402-021-03839-7

Abstract

Introduction: Tibial shaft fractures are common occurrence in children and surgical treatment is sometimes required, particularly in unstable or open fractures, and in polytrauma. The aim of this study was to investigate the available evidence on the efficacy and safety of flexible intramedullary nailing (FIN) for both open and closed tibia fractures in children, exploring the main surgical outcomes and rate of complications.

Materials and methods: Pubmed/Medline, Scopus and Cochrane Central databases were searched following the PRISMA guideline. Studies reporting on the outcomes of FIN for paediatric tibia shaft fractures were included. Weighted means were evaluated for surgical outcomes. Meta-analysis of proportion and odd ratios were used to analyse total complication rates and differences between open and closed fractures.

Results: Twenty-eight studies (835 patients) were included; the mean age was 11.0 ± 3.0 years. The mean follow-up was 22.5 ± 13.5 months; the mean time to full weight-bearing was 7.5 ± 3.7 weeks. The total complication rate was 28.1% (minor = 20.7%, major = 6.3%); this was greater in open fractures (13.6% vs 5.1%, p = 0.007). The rate of union was 97.5%, with a mean time to union of 11.9 ± 7.2 weeks. Malunion was found in 8.5% cases, delayed union in 3.8%, non-union in 1.4%, symptomatic hardware in 5.1%, leg-length discrepancy in 5.0%, superficial infections in 2.3%, deep infections in 1.0%, compartment syndromes in 1.4%, and refracture in 0.2%. Almost all patients returned to unrestricted physical activity.

Conclusions: FIN offers excellent outcomes for the treatment of paediatric tibia shaft fractures. Patients presenting with an open fracture have a higher but acceptable complication rate. Comparative studies are needed to clarify if other treatments have superior outcomes.

Keywords: Children; Fixation; Intramedullary nailing; Malunion; Tibia fracture; Trauma.

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Comparison of Three Surgical Options for Treatment of Diaphyseal Tibia Fractures in Pediatric Patients.
Lee SW, Stewig B, Cook D, Alves K, Assignon AB, Hedequist D, Kocher MS, Shore BJ, Mahan ST. Lee SW, et al. J Pediatr Soc North Am. 2025 May 26;12:100210. doi: 10.1016/j.jposna.2025.100210. eCollection 2025 Aug. J Pediatr Soc North Am. 2025. PMID: 40756145 Free PMC article.

References

1. Galano GJ, Vitale MA, Kessler MW et al (2005) The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 25:39–44. https://doi.org/10.1097/00004694-200501000-00010 - DOI - PubMed
1. Swindells MG, Rajan RA (2010) Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. J Child Orthop 4:45–51. https://doi.org/10.1007/s11832-009-0223-4 - DOI - PubMed
1. Mashru RP, Herman MJ, Pizzutillo PD (2005) Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 13:345–352. https://doi.org/10.5435/00124635-200509000-00008 - DOI - PubMed
1. Norman D, Peskin B, Ehrenraich A et al (2002) The use of external fixators in the immobilization of pediatric fractures. Arch Orthop Trauma Surg 122:379–382. https://doi.org/10.1007/s00402-001-0383-2 - DOI - PubMed
1. Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26:827–834. https://doi.org/10.1097/01.bpo.0000235397.64783.d6 - DOI - PubMed

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[1] Galano GJ, Vitale MA, Kessler MW et al (2005) The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 25:39–44. https://doi.org/10.1097/00004694-200501000-00010 - DOI - PubMed

[2] Galano GJ, Vitale MA, Kessler MW et al (2005) The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 25:39–44. https://doi.org/10.1097/00004694-200501000-00010 - DOI - PubMed

[3] Swindells MG, Rajan RA (2010) Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. J Child Orthop 4:45–51. https://doi.org/10.1007/s11832-009-0223-4 - DOI - PubMed

[4] Swindells MG, Rajan RA (2010) Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. J Child Orthop 4:45–51. https://doi.org/10.1007/s11832-009-0223-4 - DOI - PubMed

[5] Mashru RP, Herman MJ, Pizzutillo PD (2005) Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 13:345–352. https://doi.org/10.5435/00124635-200509000-00008 - DOI - PubMed

[6] Mashru RP, Herman MJ, Pizzutillo PD (2005) Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 13:345–352. https://doi.org/10.5435/00124635-200509000-00008 - DOI - PubMed

[7] Norman D, Peskin B, Ehrenraich A et al (2002) The use of external fixators in the immobilization of pediatric fractures. Arch Orthop Trauma Surg 122:379–382. https://doi.org/10.1007/s00402-001-0383-2 - DOI - PubMed

[8] Norman D, Peskin B, Ehrenraich A et al (2002) The use of external fixators in the immobilization of pediatric fractures. Arch Orthop Trauma Surg 122:379–382. https://doi.org/10.1007/s00402-001-0383-2 - DOI - PubMed

[9] Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26:827–834. https://doi.org/10.1097/01.bpo.0000235397.64783.d6 - DOI - PubMed

[10] Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26:827–834. https://doi.org/10.1097/01.bpo.0000235397.64783.d6 - DOI - PubMed

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Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis

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Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis

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