Outcome of Diaphyseal Fracture of Tibia Treated with Flexible Intramedullary Nailing in Pediatrics Age Group; A Prospective Study

Fracture of Tibia is the most common amongst pediatric fractures. Most tibial shaft fractures are treated conservatively with close reduction and above knee cast application. Surgery is indicated only when the fracture is unstable, open fracture and associated with multiple injuries. Flexible intramedullary nailing is commonly used for diaphyseal tibial fracture and is also well used in other long bone fracture. The advantages of flexible intramedullary nailing are minimal invasive surgery, short hospital stay and early weight bearing. The objective of this prospective study was to review the functional outcome of flexible intramedullary nailing in pediatric age group. In the study, the union time, weight bearing time and complications associated with flexible intramedullary nailing were observed. There were 18 children with fracture shaft of tibia treated at the Department of Orthopedics, Manipal Teaching Hospital, Pokhara, Nepal from April 2014 to March 2015. The protocol consisted in flexible intramedullary nailing of fracture shaft of tibia in children. Angulation, shortening and other complications were checked. In our study the average age of the patient was 8.2 years (range 6–12 years). Out of 18 children with fracture shaft of tibia 15 had close fracture and 3 had open fracture. All fracture cases treated with flexible intramedullary nailing had good alignment post operatively. The average age of the patient was 8.2 years (range 6-12 years). Sixteen children had an angulation of less than 5 degrees and 2 children had angulation of 5 to 10 degrees which was acceptable to the age group. The mean time of radiological union was 13.3 weeks with early callus formation of 4.3 weeks. The average time for full weight bearing was 8.8 weeks. The average hospital stay of the patient was 5.7 days (range from 3 to 16 days). Fixation with flexible intramedullary nails in diaphyseal fracture shaft of tibia in pediatric age group is simple, effective, minimally invasive procedure with short hospital stay and having good outcome.