Evaluation of treatment of open diaphyseal fracture of tibia in children by elastic stable intramedullary nailing

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Background In children, the guidelines for treatment of tibial open fractures are not clear. The options of treatment include debridement and casting, which may be isolated or with pins incorporated in the plaster with the possibility of loss of reduction and difficulties in wound care. External fixators, which may be circular or monoplanar, and intramedullary fixations, which provide axial stability and a good access to wound care for reconstructive soft tissue procedures, have been used. Patients and methods In the period between February 2012 to February 2014, 25 cases of open diaphyseal fractures of the tibia in children underwent debridement and fixation by elastic stable intramedullary nails. The age ranged between 5 and 12 years. There were 16 boys and nine girls. Right side was affected in 15 cases and left side was affected in 10 cases. The fractures were categorized using Gustilo–Anderson classification: type I, 10 cases; type II, nine cases; and type III, six cases, with two cases from type IIIa and four cases from type IIIb, and no cases of type IIIc. The time from injury to surgery varied from 3 to 9 h. Coverage procedures were done to six cases from Gustilo type III. All patients underwent clinical, radiographic, and by Flynn’s scoring criteria for proper evaluation. Results According to Flynn’s scoring criteria, 23 cases had excellent and satisfactory results (17 cases were excellent and six cases were satisfactory); however, two cases were poor. Conclusion Intramedullary fixation of open diaphyseal fractures of tibia in children by elastic nails is a valuable method of treatment of displaced open fractures of the tibia in skeletally immature patients, which allows a good access for wound care and provides axial stability and early motion.

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