Department of Orthopaedics and Traumatology, Orthopaedic and Traumatology Unit, Hospital Quirón Salud Toledo and Hospital Solimat Toledo,
Toledo, Spain
Division of Anaesthesia, Analgesia and Intensive Care and Pain Therapy, Department of Emergency and Major Trauma, “Ospedali Riuniti di Ancona”,
Ancona, Italy
Aim To report our indications and limitations about the use of external fixation in children. Methods It was retrospectively reviewed all tibial fractures treated with monolateral and hybrid external fixator, at our three Centres. It was included 32 fractures which did not show an acceptable reduction after an attempt under anaesthesia. The exclusion criteria were: open fractures, children with previous fractures of the lower limbs, with skeletal congenital diseases, fractures involving the physis and with neurovascular involvement. All fractures were classified according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification. An outcome was evaluated according to the time needed to obtain radiographic bone healing, the range of motion (ROM) of the ankle, the asymmetry of the lower limbs, the malunion, and complications. Results The average time of consolidation was 10.66 weeks (6-17 weeks). There were no cases of deep infection, but only seven cases of superficial pin infections. No patients reported loss of ROM of the knee or ankle. We had zero cases of residual angle greater than 5°, and in all cases the difference in length between the limbs was ˂1 cm. Conclusion The external fixation is a viable technique in the treatment of tibial fractures in children. Therefore, the external fixation, both monolateral and hybrid, should be considered a viable treatment for this type of fracture.
Wegmann H, Orendi I, Singer G, Eberl R, Castellani C, Schalamon J, et al. The epidemiology of fractures in infants -Which accidents are preventable? Vol. 47, Injury. 2016. p. 188–91.
2.
Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. Vol. 14, BMC Pediatr. 2014.
3.
Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in children and adolescents. Vol. 13, J Am Acad Orthop Surg. 2005. p. 345–52.
4.
Palmu SA, SampoAuro ML, Paukku RT, Peltonen JI, children Y. A retrospective 27-year follow-up study. Vol. 85, Acta Orthop. 2014. p. 513–7.
5.
Yang J, Letts M. Isolated fractures of the tibia with intact fibula in children: A review of 95 patients. Vol. 17, J PediatrOrthop. 1997. p. 347–51.
6.
Heinrich SD, Mooney JF. Fractures of the shaft of the tibia and fibula. Vol. 25, Fractures in Children. 2010.
GS B, LS W, EC Y. Treatment of type II and type III open tibia fractures in children. Vol. 11, J Orthop Trauma. 1997. p. 357–62.
9.
Humphrey JA, Gillani S, Barry MJ. The role of external fixators in paediatric trauma. Vol. 81, Acta Orthop Belg. 2015. p. 363–7.
10.
Goodwin RC, Gaynor T, Mahar A. Intramedullary flexible nail fixation of unstable pediatric tibialshaft fractures. Vol. 25, J Pediatr Orthop. 2005. p. 570–6.
11.
Kubiak EM, Egal KA, Scher D. Operative treatment of tibial fractures in children: Are elastic stable intramedullary nails an improvement over external fixation? Vol. 87, J Bone Joint Surg Am. 2005. p. 1761–8.
12.
Sviestina I, Mozgis J, Mozgis D. Analysis of antibiotic surgical prophylaxis in hospitalized children suffering upper and lower extremity injuries. Vol. 38, Int J Clin Pharm. 2016. p. 233–7.
13.
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. Vol. 21, J Pediatr Orthop. 2001. p. 4–8.
14.
Setter KJ, Palomino KE. Pediatric tibia fractures: current concepts. Vol. 18, Curr Opin Pediatr. 2006. p. 30–5.
15.
Lee SH, Hong JY, Bae JH, Park JW, Park JH. Factors related to leg length discrepancy after flexible intramedullary nail fixation in pediatric lower-extremity fractures. Vol. 24, J Pediatr Orthop B. 2015. p. 246–50.
16.
Bisaccia M, Manni M, Colleluori G, Falzarano G, Medici A, Meccariello L, et al. The management of pin-care in external fixation technique: povidone-iodine versus sodium hypochlorite 0.05% (amukina-med) medications. Vol. 11, Euromediterranean Biomedical Journal. 2016. p. 81–7.
17.
Galano GJ, Vitale MA, Kessler MW, Hyman JE, Vitale MG. The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. Vol. 25, J Pediatr Orthop. 2005. p. 39–44.
18.
Stenroos A, Laaksonen T, Nietosvaara N, Jalkanen J, Nietosvaara Y. One in three of pediatric tibia shaft fractures is currently treated operatively: a 6-year epidemiological study in two university hospitals in Finland treatment of pediatric tibia shaft fractures. Vol. 107, Scand J Surg. 2018. p. 269–74.
19.
Rose S, Marzi I. Tibial shaft fractures in children. Vol. 15, Trauma und Berufskrankheit. 2013. p. 212–6.
20.
Malhotra K, Pai S, Radcliffe G. Do minimally displaced, closed tibial fractures in children need monitoring for compartment syndrome? Vol. 46, Injury. 2015. p. 254–9.
21.
Griffet J, Leroux J, Boudjouraf N, Abou-Daher A, El Hayek T. Elastic stable intramedullary nailing of tibial shaft fractures in children. Vol. 5, J Child Orthop. 2011. p. 297–304.
22.
Zarad AL. Flexible intramedullary nails for unstable fractures of the tibia in children: a retrospective evaluation effectiveness. Vol. 49, Egypt Orthop J. 2014. p. 281–5.
23.
Slongo T, Audigé L, Hunter JB, Berger SM. Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children. Vol. 37, Eur J Trauma Emerg Surg. 2011.
24.
Vallamshetla VR, Silva U, Bache CE, Gibbons PJ. Flexible intramedullary nails for unstable fractures of the tibia in children. An eight-year experience. Vol. 88, J Bone Joint Surg Br. 2006. p. 536–40.
25.
Lieber J, Schmittenbecher P. Developments in the treatment of pediatric long bone shaft fractures. Vol. 23, Eur J Pediatr Surg. 2013. p. 427–33.
26.
Heo J, Oh CW, Park KH, Kim JW, Kim HJ, Lee JC, et al. Elastic nailing of tibia shaft fractures in young children up to 10 years of age. Vol. 47, Injury. 2016. p. 832–6.
27.
Tu KK, Zhou XT, Tao ZS, Chen WK, Huang ZL, Sun T, et al. Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures. Vol. 46, Injury. 2015. p. 2428–32.
28.
Sink EL at all Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. Vol. 25, J Pediatr Orthop. 2005. p. 577–80.
29.
al NU. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. Vol. 24, J Pediatr Orthop. 2004. p. 363–9.
30.
Marengo L, Paonessa M, Andreacchio A, Dimeglio A, Potenza A, Canavese F. Displaced tibia shaft fractures in children treated by elastic stable intramedullary nailing: results and complications in children weighing 50 kg (110 lb) or more. Vol. 26, Eur J Orthop Surg Traumatol. 2016. p. 311–7.
31.
Gordon JE, Gregush RV, Schoenecker PL, Dobbs MB, Luhmann SJ. Complications after titanium elastic nailing of pediatric tibial fractures. Vol. 27, J Pediatr Orthop. 2007. p. 442–6.
32.
Deakin DE, Winter H, Jain P, Bache CE. Malunion following flexible intramedullary nails for tibial and femoral fractures in adolescents. Vol. 4, J Child Orthop. 2010. p. 571–7.
33.
Mashru RP, Herman MJ. Pizzutillo PD Tibial shaft fractures in children and adolescents. Vol. 13, J Am AcadOrthop Surg. 2005. p. 345–52.
34.
Aslani H, Tabrizi A, Sadighi A, Mirblok AR. Treatment of open pediatric tibial fractures by external fixation versus flexible intramedullary nailing: a comparative study. Vol. 2, Arch Trauma res. 2013. p. 108–12.
35.
Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. Vol. 78, J Bone Joint Surg Br. 1996. p. 710–7.
36.
Ramasubbu RA, Ramasubbu BM. Surgical stabilization for open tibial fractures in children: External fixation or elastic stable intramedullary nail - which method is optimal? Vol. 50, Indian J Orthop. 2016. p. 455–63.
37.
Bisaccia M, Meccariello L, Manni M, Falzarano G, Medici A, Rinonapoli G, et al. Treatment of acute proximal humeral fractures in children with modular external fixator. Vol. 5, Journal of Acute Disease. 2016. p. 497–501.
38.
GJ DR, BD C. External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft. Vol. 14(10, J Am Acad Orthop Surg. 2006.
39.
Franzese R, Conte M, Gagliardo N, Pieretti G. Children vs elderly in orthopedic surgery site of infection. Are there difference? Experience of a high volume plastic surgeon consultant. Vol. 49, Acta Med Sal. 2019. p. 24–9.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
