Management of Tibia Shaft Fractures Children with Titanium Elastic Nailing: A Prospective Study

Introduction Surgical indications for tibial fractures in children include associated fractures and soft tissue injuries such as open fractures. Titanium elastic nails (TENs) are often used for pediatric tibia fractures, and have the advantage of preserving the open physis. However, complications such as delayed union or non union are not uncommon in older children or open fractures. In the present study, we evaluated children with closed or open tibial shaft fractures treated with titanium elastic nailing technique. Methods A total of 32 tibia shaft fractures were treated by elastic nailing from May 2016 to June 2017 at Govt Medical College and Hosptal, Jammu. The mean patient age at operation was 6 years (range 510 years).26 of 32 cases were open fractures (grade I 8, grade II 12, grade IIIA 6 cases). Closed antegrade intramedullary nailing was used to insert two nails through the proximal tibial metaphysis. All patients were followed up for at least one year after the injury. Outcomes were evaluated using modified Flynns criteria, including union, alignment, leg length discrepancies, and complications. Results All fractures achieved union a mean of 20.1 weeks after surgery (range 1126 weeks). One patient reported knee pain and two experienced restricted knee motion. There were two cases of superficial infection in patients with grade III open fracture. Six patients reported soft tissue discomfort due to prominent TEN tips at the proximal insertion site, which required removing the nail after union. At the last follow-up, there were no angular or rotational deformities in either the sagittal or coronal planes. No patient showed shortening or overgrowth exceeding 10 mm. Among final outcomes, 30 were excellent and 2 were satisfactory. Summary Elastic nailing can achieve satisfactory results in young children even with open fractures or soft tissue injuries with minimal complications of delayed bone healing, or infection.