Elastic stable intramedullary nailing for pediatric tibial shaft fractures: a prospective observational study of clinical, radiological and functional outcomes
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262909Keywords:
Pediatric tibial shaft fracture, ESIN, Fracture union, Flynn's criteria, Functional outcomeAbstract
Background: Pediatric tibial shaft fractures are among the most common long-bone injuries in children. Although stable fractures can be managed conservatively, unstable or displaced fractures often require surgical stabilization. Elastic stable intramedullary nailing (ESIN) provides minimally invasive fixation while preserving fracture biology and allowing early mobilization. This study evaluated the clinical, radiological, and functional outcomes of ESIN in pediatric tibial shaft fractures.
Methods: This prospective observational study included 40 children aged 3–15 years with closed or Gustilo–Anderson grade I open tibial shaft fractures treated with ESIN at a tertiary care centre between October 2023 and November 2025. Patients were followed for 12 months. Outcome measures included radiological union using the modified radiographic union score for tibial fractures (mRUST), pain using the visual analogue scale (VAS), knee and ankle range of motion (ROM), time to weight-bearing, alignment, complications, and functional outcome using Flynn's criteria.
Results: The mean age was 10.7±2.9 years, and 72.5% of patients were male. Mean operative time was 60.5±9.5 minutes with mean blood loss of 20.8±7.3 ml. Radiological healing, pain, and functional outcomes improved significantly throughout follow-up (all p<0.001). Mean time to radiological union was 9.4±1.9 weeks, with full weight-bearing achieved at 10.7±2.1 weeks. At 12 months, 85% of patients had excellent and 15% had satisfactory outcomes according to Flynn's criteria. One patient (2.5%) developed a superficial wound infection; no non-union, malalignment, or significant limb-length discrepancy was observed.
Conclusions: ESIN is a safe, effective, and minimally invasive treatment for pediatric tibial shaft fractures, providing reliable fracture union, excellent functional recovery, and a low complication rate.
References
Sleem B, Khalek JA, Hajj A. Pediatric tibial shaft fractures: a comprehensive review. Athenaeum Int J Orthop. 2024;6(4).
Mounasamy V, Patel N, Horstman J, Kuester V, Sambandam S. Pediatric tibial shaft fractures. Indian J Orthop. 2018;52(5):522.
Sankar WN, Jones KJ, Horn BD, Wells L. Titanium elastic nails for pediatric tibial shaft fractures. J Child Orthop. 2007;1(5):281-6.
Uludağ A, Tosun HB. Treatment of unstable pediatric tibial shaft fractures with titanium elastic nails. Medicina (Kaunas). 2019;55(6):266.
Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26(6):827-34.
Pogorelić Z, Vegan V, Jukić M, Furlan D, Jurić I. Elastic stable intramedullary nailing for treatment of pediatric tibial fractures: a 20-year single-center experience of 132 cases. Children (Basel). 2022;9(6):792.
Joeris A, Lutz N, Blumenthal A, Slongo T, Audige L. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF): part I. Acta Orthop. 2017;88(1):7-9.
Pennock AT, Heyworth BE, Bastrom T, Bae DS, Busch MT, Edmonds EW, et al. Changes in superior displacement, angulation, and shortening in the early phase of healing for completely displaced midshaft clavicle fractures in adolescents: results from a prospective, multicenter study. Orthop J Sports Med. 2021;9(7 suppl3):2325967121S00031.
Palmu SA, Auro S, Lohman M, Paukku RT, Peltonen JI, Nietosvaara Y. Tibial fractures in children: a retrospective 27-year follow-up study. Acta Orthop. 2014;85(5):513-7.
Swindells MG, Rao AS, Trautner TC, Slongo T. Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. J Child Orthop. 2016;10(5):461-7.
Berger P, Metsemakers WJ, Vranckx JJ. ESIN outcomes and complications in pediatric long-bone fractures. Eur J Orthop Surg Traumatol. 2019;29:1055-63.
Kumar A, Mehtani A, Biswas D. Functional outcomes of elastic stable intramedullary nailing in pediatric tibial fractures: a multicenter prospective study. Indian J Orthop. 2021;55(4):890-7.
Downloads
Published
How to Cite
Issue
Section
