Background: Operative treatment of tibial fractures in children
requires implants that do not violate open physes while maintaining tibial
length and alignment. Both elastic stable intramedullary nails and external
fixation can be utilized. We retrospectively reviewed our experience with
these two techniques to determine if one is superior to the other.
Methods: We retrospectively reviewed the operative records and
trauma registries of three institutions within our hospital system and
identified thirty-five consecutive patients with open physes who had undergone
operative treatment of a tibial fracture between April 1997 and June 2004.
Four patients were excluded because they had been managed with locked
intramedullary nails or with pins and plaster. Of the thirty-one remaining
patients, sixteen had been managed with elastic stable intramedullary nails
and fifteen had been managed with unilateral external fixation. The clinical
and radiographic outcomes were compared. The functional outcomes were compared
with use of the Pediatric Outcomes Data Collection Instrument. Complications
related to treatment, such as malunion, delayed union, nonunion, infection,
and the need for subsequent surgical treatment also were compared.
Results: Thirty-one patients with thirty-one operatively treated
tibial fractures were available for evaluation. Fifteen patients had been
managed with external fixation. Seven of these patients had a closed fracture,
and eight had an open fracture. There were seven healing complications in this
group, including two delayed unions, three nonunions, and two malunions.
Sixteen patients had been managed with elastic stable intramedullary nailing.
Eleven patients had a closed fracture, and five had an open fracture. The mean
time to union for the intramedullary nailing group (seven weeks) was
significantly shorter than that for the external fixation group (eighteen
weeks) (p < 0.01). The functional outcomes for the intramedullary nailing
group were significantly better than those for the external fixation group in
the categories of pain, happiness, sports, and global function (the mean of
the mean scores of the first four categories) (p < 0.01 for these
Conclusions: When surgical stabilization of tibial fractures in
children is indicated, we believe that the preferred method of fixation is
with elastic stable intramedullary nailing.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.