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Chapter 30 Pediatric Tibial Fractures

■ Myers and coworkers 12 reported a significant complication rate in high-energy tibial fractures treated with external fixa- tion, including delayed union, malunion, leg length discrep- ancies, and pin tract infections. ■ Kubiak and colleagues 8 reported 2 delayed unions, 2 mal- unions, and 3 nonunions in a series of 15 patients man- aged with external fixation, although these appear to have occurred in open injuries. ■ They reported higher functional scores in their patients treated with elastic intramedullary nailing compared to external fixation. ■ Operative techniques usually require additional procedures for removal of pins or prominent nails or plates. ■ Obviously, operative complications do not occur in nonop- eratively treated patients. Knowledge of proper indications is crucial to maximize outcomes.

3. DeLong WG Jr, Born CT, Marcelli E, et al. Ender nail fixation in long bone fractures: experience in a level I trauma center. J Trauma 1989;29:571–576. 4. Furlan D, Pogorelic´ Z, Biocˇic´ M, et al. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 frac- tures. Scand J Surg 2011;100(3):208–215. 5. Gicquel P, Giacomelli M, Basic B, et al. Problems of operative and non-operative and healing in tibial fractures. Injury 2005;36(suppl 1): A44–A50. 6. Goodwin RC, Gaynor T, Mahar A, et al. Intramedullary flexible nail fixation of unstable tibial diaphyseal fractures. J Pediatr Orthop 2005;25:570–576. 7. Hunter JB. The principles of elastic stable intramedullary nailing in children. Injury 2005;36(suppl 1):A21–A24. 8. Kubiak EN, Egol KA, Scher D, et al. Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an im- provement over external fixation? J Bone Joint Surg Am 2005;87(8): 1761–1768. 9. Lascombes P, Huber H, Fay R, et al. Flexible intramedullary nailing in children: nail to medullary canal diameters optimal ratio. J Pediatr Orthop 2013;33(4):403–408. 10. Lascombes P, Nespola A, Poircuitte JM, et al. Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails. Orthop Traumatol Surg Res 2012;98(4):369–375. 11. Moulton SL. Early management of the child with multiple injuries. Clin Orthop Relat Res 2000;(376):6–14. 12. Myers SH, Speigel D, Flynn JM. External fixation of high-energy tibia fractures. J Pediatr Orthop 2007;27:537–539. 13. Norman D, Peskin B, Ehrenraich A, et al. The use of external fixators in the immobilization of pediatric fractures. Arch Orthop Trauma Surg 2002;122:379–382. 14. O’Brien T, Weisman DS, Ronchetti P, et al. Flexible titanium nailing for the treatment of unstable pediatric tibial fracture. J Pediatr Orthop 2004;24:601–609. 15. Slongo T. Complications and failures of the ESIN technique. Injury 2005;36:A78–A85.

COMPLICATIONS

■ Malunion ■ Delayed union ■ Leg length discrepancy ■ Compartment syndrome ■ Symptomatic hardware ■ Infection

REFERENCES 1. Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop 2001;21:680–688. 2. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedul- lary nailing for femoral shaft fractures in children. A prospective, ran- domised study. J Bone Joint Surg Br 1997;79(6):975–978.