O2140: Rigid Intramedullary Fixation for Pediatric Tibia Fractures in Low- and Middle-Income Countries

Background: Pediatric tibial shaft fractures are one of the most common long bone fractures in children. Although a majority of these fractures can be managed conservatively, operative options include external fixation, plate osteosynthesis, and intramedullary nails (IMN). We assessed the rates of union and painless weight-bearing after rigid IMN fixation of pediatric tibial shaft fractures in patients with open proximal tibial physes in lower-resource settings.

Methods: We queried the SIGN (Surgical Implant Generation Network) Fracture Care International online database to identify patients with tibial shaft fractures treated by rigid intramedullary nailing in the setting of an open proximal tibial physis. Patients without a minimum of 6 months follow-up were excluded. We evaluated the most recent follow-up radiograph to determine a modified Radiographic Union Scale in Tibial fractures (mRUST) score. A mRUST score of ≥11 was associated with radiographic union. We also recorded the percentage of patients that achieved painless full-weight bearing as determined by the treating surgeon.

Results: There were 58 patients with pediatric tibial fractures, including 42 males (72%) and 16 females (28%) from 15 countries. The average age at the time of surgery was 10.9 ± 2.6 years (range, 2 to 13 years). The average duration of follow-up was 1.7 years (range, 6 months to 9.7 years). Road traffic accident was the most common mechanism of injury affecting 29 patients (50%). There were 11 patients (19%) with open fractures. All patients were treated with reamed intramedullary nailing. At final follow-up, 53 patients (91%) had a mRUST score of ≥11 and 56 patients (97%) had painless full-weight bearing. There were five patients (9%) with non-union at final follow-up and one patient (2%) that developed an infection postoperatively.

Conclusion: Pediatric tibial shaft fractures treated with rigid IMN fixation achieve high rates of union and painless weight-bearing with a relatively low complication profile.