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. 2021 Mar 15;13(3):e13893.
doi: 10.7759/cureus.13893.

Physeal-Sparing Rigid Intramedullary Nailing in Adolescent Tibial Shaft Fractures: A Pilot Study

Kevin A Williams  1 , Zachary T Thier  2 , Candler G Mathews  3 , Mark D Locke  4
Affiliations

Physeal-Sparing Rigid Intramedullary Nailing in Adolescent Tibial Shaft Fractures: A Pilot Study

Kevin A Williams et al. Cureus. .

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.

Keywords: adolescent tibial fracture; intramedullary nailing; trauma pediatric.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Antero-posterior (A) and lateral (B) fluoroscopic images of the proximal tibial starting point for RIMN
RIMN: rigid intramedullary nailing
Figure 2
Figure 2. Tibial nail starting point, just lateral to the tibial tubercle apophysis and distal to the proximal tibial physis.
Figure 3
Figure 3. Pre- (A) and post-operative (B) images of physeal-sparing RIMN
RIMN: rigid intramedullary nailing
Figure 4
Figure 4. Selected outcomes between groups
RIMN: rigid intramedullary nailing; ESIN: elastic stable intramedullary nailing, ORIF: open reduction internal fixation
See this image and copyright information in PMC

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