Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2017 12 14 gregorian 2017 12 14 2 3
en 10.5812/atr.13826 Treatment of Open Pediatric Tibial Fractures by External Fixation Versus Flexible Intramedullary Nailing: A Comparative Study Treatment of Open Pediatric Tibial Fractures by External Fixation Versus Flexible Intramedullary Nailing: A Comparative Study research-article research-article Conclusions

Although external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Background

Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibia fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases.

Results

Mean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails.

Materials and Methods

In this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n = 18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years.

Objectives

In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the pediatric tibial open fractures.

Conclusions

Although external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Background

Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibia fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases.

Results

Mean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails.

Materials and Methods

In this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n = 18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years.

Objectives

In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the pediatric tibial open fractures.

Fractures, Open;External Fixator;Fracture Fixation;Child Fractures, Open;External Fixator;Fracture Fixation;Child 108 112 http://www.archtrauma.com/index.php?page=article&article_id=13826 Hossein Aslani Hossein Aslani Pediatric Orthopedic, Tehran University of Medical Sciences,Tehran, IR Iran Pediatric Orthopedic, Tehran University of Medical Sciences,Tehran, IR Iran Ali Tabrizi Ali Tabrizi Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran; Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel:+98-9148883851 Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran; Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel:+98-9148883851 Ali Sadighi Ali Sadighi Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran Ahmad Reza Mirblok Ahmad Reza Mirblok Orthopedic Surgery, Poursina Educational Hospital, Guilan University of Medical Sciences, Rasht, IR Iran Orthopedic Surgery, Poursina Educational Hospital, Guilan University of Medical Sciences, Rasht, IR Iran