Session V - Pediatrics

Fri., 10/6/06 Pediatrics & Spine, Paper #29, 11:30 am

Elastic Stable Intramedullary Nailing of Pediatric Tibial Shaft Fractures

Adarsh K. Srivastava, BS (n); Charles T. Mehlman, DO, MPH (n); Eric J. Wall, MD (n);
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Purpose: The purpose of our study was to evaluate the effectiveness of elastic stable intramedullary nail stabilization of tibial shaft fractures in children.

Methods: A computerized medical records search from 1997 to 2004 and application of our inclusion/exclusion criteria yielded 24 skeletally immature patients with a minimum of 1-year follow-up. Both closed and open tibial shaft fractures were studied and time to union (3 bridged cortices) as well as treatment complications were the main outcomes of interest.

Results: The study group consisted of 21 boys and 3 girls with an average age of 11 years (range, 4-16) and an average follow-up of 2 years 5 months (range, 1 year-6 years 10 months). 16 patients suffered open fractures, while 8 suffered closed fractures. Among the 16 open fractures, there were 2 Gustilo I, 6 Gustilo II, and 8 Gustilo III. The average time to union for all fractures was 20.7 weeks. The average time to union for closed fractures was 21.5 weeks, while the average time to union for open fractures was 20.2 weeks. There were 2 nonunions in our study (both type III fractures). Other complications included 1 lower leg compartment syndrome, 1 leg-length discrepancy, and 2 cases of osteomyelitis (1 in a closed fracture and 1 in a type III open fracture).

Conclusion/Significance: Elastic stable intramedullary nailing is an effective means of tibial shaft fracture stabilization in children. Our series is strongly weighted towards open fractures (the number of Type III open fractures being equal to the number of closed fractures). We were surprised by the time to union being so similar in our open and closed fracture subgroups. We are most concerned by 2 complications in the closed fracture group (1 deep infection and 1 compartment syndrome).

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.