Outcomes Of Open Pediatric Tibial Fractures by Titanium Elastic Nail Versus  External Fixation

Dr Pathik Vala; Dr Ajay Devda; Dr Mehul Vardey; Dr Tushar Kunder

Volume : V, Issue : X, October - 2016

Outcomes Of Open Pediatric Tibial Fractures by Titanium Elastic Nail Versus External Fixation

Dr Pathik Vala, Dr Ajay Devda, Dr Mehul Vardey, Dr Tushar Kunder

Abstract :

Background Tibial fractures are the third most common pediatric long bone fractures after forearm and femur fracture. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fracture(39%),and least commonly, the proximal third of the tibia is involved. Tibial fractures in a skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering the type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatment for children fractures. They are used following compartment syndromes in polytrauma , neurovascular damage, open fractures and fasciotomy cases. Objectives In children, most open fractures occur due to high energy trauma 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 comp� results of these two treatment methods in the pediatric tibial open fractures. Materials and Methods In the descriptive analysis study, 32 patients with open tibial fractures were treated with either external fixator(n=18) or TEN nails(n=14) during 2012-2015.Some patients were treated with a combination methods of TEN and pin. The results were evaluated considering infection, union, malunion and refracture and the patients were followed up for 2 years. 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(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 only report of mal union requiring correction in the groups .No complications was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails. 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.