Jsmc-10363

THE FUNCTIONAL OUTCOME OF ELASTIC STABLE INTRAMEDULLARY NAILING FOR DIAPHYSEAL TIBIAL FRACTURES IN CHILDREN

Sangar Anwar Karim a, Omer Ali Rafiq Barawi b, and Aso Ali Baker c

a K.B.M.S (Orthopedic) trainee. Shar Teaching Hospital, Sulaimani City, Kurdistan Region, Iraq.

b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

c Shar Teaching Hospital, Sulaimani City, Kurdistan Region, Iraq.

Submitted: 26/2/2022; Accepted: 17/7/2022; Published: 21/9/2022

DOI Link: https://doi.org/10.17656/jsmc.10363 

ABSTRACT 

Background 

Fracture of the tibia is a common fracture among children. A method that has become popular among surgeons in recent years for treating tibial fractures is the elastic stable intramedullary nailing technique. It has many advantages compared to conventional methods in that it has faster healing, earlier weight bearing, and fewer complications.

Objectives 

The objective is to assess the outcome of the intramedullary nailing technique used to treat diaphyseal fractures of the tibia according to clinical and radiological measurements.

Materials and Methods

This prospective observational study analyzes 37 cases of fractured tibiae, aged between 4 and 11 years, treated by elastic intramedullary nailing technique. The duration of sample collection was from Aug. 1, 2020, to Feb. 1, 2022. Follow-up appointments were scheduled in weeks 2, 4, 6, 10, and 20 after the surgery, and a final follow-up after one year for removing titanium stable elastic IM nailing. The samples were analyzed by using Flynn’s criteria score system.

Results

86.5% of the samples scored excellently, 10.8% scored satisfactorily, and 2.7% scored poor according to Flynn’s criteria. Full weight bearing was achieved in the average time of 9.1 weeks. It was determined that there is a significant correlation between the level of fracture, time of weight bearing, the pattern of fracture, and body weight with the variables of Flynn’s criteria. 

Conclusion

Elastic intramedullary nailing technique is a productive approach for managing tibial fractures in children. They are less invasive, carry fewer complications, and have a high prevalence of “good” and “excellent” outcomes in pediatric patients.

KEYWORDS

ESIN (Elastic Stable Intramedullary Nail), Pediatric Patient, Fractured Tibia.

References 

1. Egger A, Murphy J, Johnson M, Hosseinzadeh P, Louer C. Elastic Stable Intramedullary Nailing of Pediatric Tibial Fractures. JBJS Essential Surgical Techniques. 2020 Oct;10(4).

2. Ligier JN, Metaizeau JP, Prévot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. The Journal of bone and joint surgery. British volume. 1988 Jan;70(1):74-7.

3. Griffet J, Leroux J, Boudjouraf N, Abou-Daher A, El Hayek T. Elastic stable intramedullary nailing of tibial shaft fractures in children. Journal of children's orthopaedics. 2011 Aug 1;5(4):297-304.

4. O'Brien T, Weisman DS, Ronchetti P, Piller CP, Maloney M. Flexible titanium nailing for the treatment of the unstable pediatric tibial fracture. Journal of Pediatric Orthopaedics. 2004 Nov 1;24(6):601-9.

5. Lascombes P, Nespola A, Poircuitte JM, Popkov D, De Gheldere A, Haumont T, Journeau P. Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with pre-curved tip and shaft nails. Orthopaedics & Traumatology: Surgery & Research. 2012 Jun 1;98(4):369-75.

6. Shen K, Cai H, Wang Z, Xu Y. Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children. Medicine. 2016 Sep;95(39).

7. Parekh MN. Treatment of Paediatric Femoral Shaft Fracture with Flexible Intramedullary Nail. Journal of Surgery Pakistan. 2020 May 15;25(1):13-7.

8. Slongo T, Audigé L, Hunter JB, Berger SM. Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children. European journal of trauma and emergency surgery. 2011 Jun;37(3):305-12.

9. Moroz LA, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, Flynn JM. Titanium elastic nailing of fractures of the femur in children: predictors of complications and poor outcome. The Journal of bone and joint surgery. British volume. 2006 Oct;88(10):1361-6.

10. Li Y, Stabile KJ, Shilt JS. Biomechanical analysis of titanium elastic nail fixation in a pediatric femur fracture model. Journal of Pediatric Orthopaedics. 2008 Dec 1;28(8):874-8.

11. Edwin A, Ibad Sha I, Roshna SR, Shah N. Clinical and functional outcome of elastic stable intramedullary nailing in pediatric femoral fractures in the age group of 5-16 years. International Journal of Research in Orthopaedics. 2020 Sep;6(5):1037.

12. Meena D, Tiwari AK. Results of management of tibia shaft fractures in children with titanium elastic nailing. International Journal of Orthopaedics. 2019;5(4):878-81.

13. Uludağ A, Tosun HB. Treatment of unstable pediatric tibial shaft fractures with titanium elastic nails. Medicine. 2019 Jun;55(6):266.

14. Savery VB, Vijayakumaran R, Sankaralal T. Functional Outcome of Pediatric Long Bone Fractures in Children by Closed Reduction and Internal Fixation with Titanium Elastic Nails. Annals of the Romanian Society for Cell Biology. 2021 Mar 1:1547-78.

15. AHMAD I, AKHTAR M, QURESHI SA, NADEEM A, ILAHI D, CHAUDHARY RD, NASIR MB, TAQI M. Efficacy of Titanium Elastic Intramedullary Nailing System (TENS) in the treatment of Paediatric Tibial Shaft Fractures.

16. Caglar O, Aksoy MC, Yazc M, Surat A. Comparison of compression plate and flexible intramedullary nail fixation in pediatric femoral shaft fractures. Journal of Pediatric Orthopaedics B. 2006 May 1;15(3):210-4.

17. Eladawy AM, Megahed RM, Yosef AE, Salama MI. Management of Open Tibial Shaft Fractures in Children with Intramedullary Elastic Nail. The Egyptian Journal of Hospital Medicine. 2021 Jul 1;84(1):1984-8.

18. Goodwin RC, Gaynor T, Mahar A, Oka R, Lalonde FD. Intramedullary flexible nail fixation of unstable pediatric tibial diaphyseal fractures. Journal of Pediatric Orthopaedics. 2005 Sep 1;25(5):570-6.

19. Hong P, Rai S, Tang X, Liu R, Li J. External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children. Journal of Orthopaedic Surgery and Research. 2021 Dec;16(1):1-7.

20. Jayaram BS, Kishor R, Shivanand S, Radakrishna AM. To study the functional outcome of femoral and tibial shaft fractures in children treated by tens nail. International Journal of Orthopaedics. 2021;7(3):865-9.

21. KC KM, Acharya P, Sigdel A. Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications. Journal of the Nepal Medical Association. 2016 Oct 1;55(204).

22. Nisar A, Bhosale A, Madan SS, Flowers MJ, Fernandes JA, Jones S. Complications of elastic stable intramedullary nailing for treating paediatric long bone fractures. Journal of orthopaedics. 2013 Mar 1;10(1):17-24.

23. Onta PR, Thapa P, Sapkota K, Ranjeet N, Kishore A, Gupta M. Outcome of diaphyseal fracture of tibia treated with flexible intramedullary nailing in paediatrics age group; A prospective study. Am. J. Public Health. 2015 Jun 15; 3:65-8.

24. Panthi S, Shrestha R, Pradhan J, Neupane B, Bhusal I, Karki A. Diaphyseal Femur Fracture in Paediatric Age group: Outcome with fixation by Elastic Nailing System. Europasian Journal of Medical Sciences. 2021 Nov 22;3(1):1-5.

25. Sankar WN, Jones KJ, David Horn B, Wells L. Titanium elastic nails for pediatric tibial shaft fractures. Journal of children's orthopaedics. 2007 Nov 1;1(5):281-6.

26. Tamrakar R, Basnyat S, Shah GM, Bhatta TR, Gyawali B, Acharya BM, Shrestha SK, Pradhan NM. Flexible intramedullary nailing for femoral diaphyseal fractures in children. Journal of College of Medical Sciences-Nepal. 2017 Dec 20;13(4):420-4.

27. Tawfeeq RA, Saeed OA. Flexible intramedullary nail fixation for paediatric tibial diaphysis fractures. Journal of Kurdistan Board of Medical Specialties. 2020;6(1).

28. Vashisht A, Sharma GD. Study on Functional Outcome of Elastic Stable Intramedullary Nailing (ESIN) of Diaphyseal Fractures of Paediatric Long Bones. New Frontiers in Medicine and Medical Research Vol. 11. 2021 Aug 28:1-9.

29. Vallamshetla VR, De Silva U, Bache CE, Gibbons PJ. Flexible intramedullary nails for unstable fractures of the tibia in children: An eight-year experience. The Journal of bone and joint surgery. British volume. 2006 Apr;88(4):536-40.

30. Widbom-Kolhanen S, Helenius I. Intramedullary Nailing of Paediatric Tibial Fractures: Comparison between Flexible and Rigid Nails. Scandinavian Journal of Surgery. 2021 Jun;110(2):265-70.

Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.