ArticleJournal of the Pediatric Orthopaedic Society of North America2025
Comparison of Three Surgical Options for Treatment of Diaphyseal Tibia Fractures in Pediatric Patients.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Most pediatric diaphyseal tibia fractures can be treated with reduction and casting. While surgical reduction and fixation are sometimes necessary, there is no clear consensus about the optimal implant. Plate osteosynthesis (PO), elastic intramedullary nailing (EIN), and multiplanar external fixation (MEF) are common surgical fixation methods in the skeletally immature patient after failing closed reduction. This study aims to compare the indications and outcomes of PO, EIN, and MEF techniques for the surgical treatment of the pediatric diaphyseal tibia fracture. Methods: Skeletally immature patients ages 4-16 years treated surgically by PO, EIN, or MEF for a diaphyseal tibia fracture at a single, tertiary pediatric hospital were included. Demographic, clinical, radiographic data, and complications were collected retrospectively. Complications were classified according to the Clavien-Dindo-Sink classification. Results: In total, 82 patients were included with a median age of 13.4 years (range, 5.69-15.94) and median follow-up of 46 weeks (range, 14-237), of whom 84% (69/82) were male. Most patients received EIN (61%; 50/82), while 23% (19/82) had MEF, and 16% (13/82) had PO. There were no differences across treatment groups for open ( Conclusion: All three fixation types (PO, EIN, and MEF) show similar indications, although fracture location in the diaphysis may influence implant choice. EIN has a lower complication rate compared with PO and MEF and presents a strong option for operative treatment of the pediatric tibia shaft fracture. Key Concepts: (1)There is no clear consensus about optimal implant, including plate osteosynthesis (PO), elastic intramedullary nailing (EIN), and multiplanar external fixation (MEF), for the surgical treatment of skeletally immature tibial shaft fractures.(2)Among 82 patients with pediatric tibial diaphysis fractures, most patients received EIN (61%; 50/82), while 23% (19/82) had MEF, and 16% (13/82) had PO with no difference across treatment groups in terms of open ( Level of Evidence: Level III: Case-control study or retrospective cohort study.
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