Objectives: In this prospective study we studied radiological and functional outcomes of unstable tibial shaft fractures in adolescent age group that were managed by titanium elastic nailing. Although most pediatric tibial shaft fractures are managed by closed reduction and casting, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) have emerged as a suitable surgical modality for pediatric tibia fractures owing to the benefits such as easy surgical technique, early weight-bearing, early union and early discharge from hospital.

Materials and Methods: In this prospective study we managed 25 patients of unstable tibial diaphyseal fractures by TENs nailing. The mean age at injury was 10 years and 6 days (range of 8–17) years. In each patient, ante-grade nailing was performed by inserting a TENs nail in the medial and another TENs nail in the lateral side of the proximal metaphysis. Modified Flynn’s criteria were used to assess union, alignment, leg-length inequality and complications.

Results: All the patients’ fractures got united and the healing time was 10 weeks and 5 days in average. No case of nonunion or significant malunion or epiphyseal injury was encountered. No patient had a sagittal or coronal angulation of over 10°. Among patients with open fractures, four had superficial surgical site infections and one had a deep wound infection. All the infections were successfully treated with appropriate antibiotics. Patients with open fractures took longer time to heal than close fractures. Nearly full range of motion was achieved at knee and ankle in all cases. 16 (64%) patients had an excellent outcome, and 9 (36%) patients had a satisfactory outcome.

Conclusion: For unstable tibial shaft fractures in adolescent age group, TENs is a  safe and effective treatment modality. It is minimally –invasive, thus causes less soft tissue injury, short surgery time, rapid recovery and fewer complications.

Keywords:  Unstable tibial diaphyseal fractures, Adolescent age group, TENs.

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Dr Sayar Ahmad Mantoo

Senior Resident Orthopaedics, GMC Srinagar, J&K