Marsiolo Martina, Aulisa Angelo Gabriele, Masci Giulia, Poggiaroni Alessia, Giordano Marco, Calogero Valeria, Falciglia Francesco
U.O.C. of Orthopaedics and Traumatology, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy.
Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043, Cassino, FR, Italy.
J Orthop Traumatol. 2025 Jul 24;26(1):50. doi: 10.1186/s10195-025-00866-7.
Diaphyseal leg fractures are common in pediatric age, and the most used treatment is surgery using elastic stable intramedullary nailing (ESIN). In the past, a cutoff of 50 kg was the limit of weight indication for the use of ESIN. In literature, the concept of BMI has recently been introduced to evaluate the results owing to an increase in the incidence of obesity in children; up to now, it has only been used in one study for the femur but never in the tibia, although more than one author suggests doing so. The objective of this study was to research a correlation between weight, BMI, and the results of ESIN treatment.
A total of 84 patients treated with ESIN from 2013 to 2021 were included; the inclusion criteria were clinical and radiographic data until complete healing and the presence of weight and height data collection; patients with an exposed fracture or neurovascular injury were excluded. The following were evaluated: clinical healing time in terms of load resumption (CHT), radiographic healing time (RHT), anteroposterior (APA) and lateral (LA) radiographic alignment, surgical time (CT), nonunion (NU), and delayed union (DC). Patients were divided into two weight groups (< 50; > 50). The statistical analysis was performed using STATA (Stata, College Station, TX, USA), and a p-value less than 0.05 was considered statistically significant. The Shapiro-Francia test was used to check the normality of each variable. Pearson's correlation coefficient was calculated for the correlation between variables.
A total of 84 patients with an average weight of 41.53 kg (18-85 kg) were included. Patients were divided into two groups; 62 patients weighing < 50 kg (GR1) and 22 patients weighing > 50 kg (GR2). We found a statistically significant correlation between weight and CHT, RHT, and ST and between BMI and CHT, RHT, and ST. Average results: GR1: CHT 55.84 days; RHT 48.79 days; ST 61.68 min and GR2: CHT 63.27 days; RHT 55.77 days, ST 79.32. We found no significant difference in CHT and RHT between the two groups, while a significant difference for ST was observed.
We confirm that ESIN nails can also be used in patients weighing > 50 kg affected by tibial shaft fractures; in fact, we found no statistical differences between the two groups' clinical and radiographic healing times. Moreover, we found no difference in results between weight and BMI for tibial shaft fracture. The statistical difference correlation in ST between GR1 and GR2 does not imply an important difference in clinical practice.
胫骨干骨折在儿童期很常见，最常用的治疗方法是采用弹性稳定髓内钉（ESIN）进行手术。过去，50kg是使用ESIN的体重指征上限。在文献中，由于儿童肥胖发生率的增加，最近引入了BMI概念来评估结果；到目前为止，它仅在一项关于股骨的研究中使用过，而在胫骨研究中从未使用过，尽管不止一位作者建议这样做。本研究的目的是探讨体重、BMI与ESIN治疗结果之间的相关性。
纳入2013年至2021年期间接受ESIN治疗的84例患者；纳入标准为直至完全愈合的临床和影像学数据以及体重和身高数据的收集；排除有开放性骨折或神经血管损伤的患者。评估以下指标：负荷恢复方面的临床愈合时间（CHT）、影像学愈合时间（RHT）、前后位（APA）和侧位（LA）影像学对线、手术时间（CT）、骨不连（NU）和延迟愈合（DC）。患者分为两个体重组（<50kg；>50kg）。使用STATA（美国德克萨斯州大学站的Stata公司）进行统计分析，p值小于0.05被认为具有统计学意义。采用夏皮罗-弗朗西亚检验来检查每个变量的正态性。计算变量之间的皮尔逊相关系数。
共纳入84例平均体重为41.53kg（18 - 85kg）的患者。患者分为两组；62例体重<50kg（GR1），22例体重>50kg（GR2）。我们发现体重与CHT、RHT和ST之间以及BMI与CHT、RHT和ST之间存在统计学显著相关性。平均结果：GR1：CHT 55.84天；RHT 48.79天；ST 61.68分钟；GR2：CHT 63.27天；RHT 55.77天，ST 79.32分钟。我们发现两组之间CHT和RHT无显著差异，而ST存在显著差异。
我们证实ESIN钉也可用于体重>50kg的胫骨干骨折患者；事实上，我们发现两组的临床和影像学愈合时间无统计学差异。此外，我们发现胫骨干骨折患者的体重和BMI结果无差异。GR1和GR2之间ST的统计差异相关性在临床实践中并不意味着存在重要差异。
