Lee Sang Won, Stewig Blair, Cook Danielle, Alves Kristin, Assignon Akossiwa Brynn, Hedequist Daniel, Kocher Mininder S, Shore Benjamin J, Mahan Susan T
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Pediatr Soc North Am. 2025 May 26;12:100210. doi: 10.1016/j.jposna.2025.100210. eCollection 2025 Aug.
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.
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.
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 ( = .96) and comminuted ( = .19) fractures. Location of fracture was significantly different by treatment method, with middle 1/3 fractures treated mostly by EIN (77%; 34/44) and distal 1/3 fractures treated across all three fixation methods ( = .002). Patients treated with MEF (47%; 9/19) and PO (46%; 6/13) had higher complication rates compared with those treated with EIN (22%; 11/50). Patients treated with PO and MEF had 6.0 and 6.2 times the odds of having a severe complication, compared to patients who had EIN, controlling for age, weight, and fracture severity ( = .01, = .02). There was no significant difference in other fracture characteristics and outcomes.
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.
(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 ( = .96) or comminuted ( = .19) fractures.(3)Location of fracture was significantly different by treatment method, with middle 1/3 fractures treated mostly by EIN (77%; 34/44) and distal 1/3 fractures treated across all three fixation methods ( = .002).(4)Patients treated with EIN (22%; 11/50) had a lower complication rate compared with those treated with MEF (47%; 9/19) and PO (46%; 6/13). Patients treated with PO and MEF had 6.0 and 6.2 times the odds of having a severe complication compared with those treated with EIN, controlling for age, weight, and fracture severity ( = .01, = .02).(5)All three fixation types show similar indications, although fracture location in the diaphysis may influence implant choice, and EIN presents a strong option for operative treatment of the pediatric tibia shaft fracture with a lower complication rate.
Level III: Case-control study or retrospective cohort study.
大多数小儿胫骨干骨折可通过复位和石膏固定进行治疗。虽然有时需要手术复位和固定，但对于最佳植入物尚无明确共识。钢板内固定（PO）、弹性髓内钉固定（EIN）和多平面外固定（MEF）是骨骼未成熟患者闭合复位失败后常用的手术固定方法。本研究旨在比较PO、EIN和MEF技术治疗小儿胫骨干骨折的适应症和疗效。
纳入在一家三级儿科医院接受PO、EIN或MEF手术治疗胫骨干骨折的4-16岁骨骼未成熟患者。回顾性收集人口统计学、临床、影像学数据及并发症情况。并发症根据Clavien-Dindo-Sink分类法进行分类。
共纳入82例患者，中位年龄13.4岁（范围5.69-15.94岁），中位随访46周（范围14-237周），其中84%（69/82）为男性。大多数患者接受EIN治疗（61%；50/82），23%（19/82）接受MEF治疗，16%（13/82）接受PO治疗。各治疗组在开放性骨折（P = 0.96）和粉碎性骨折（P = 0.19）方面无差异。骨折部位因治疗方法不同存在显著差异，中1/3骨折大多采用EIN治疗（77%；34/44），远1/3骨折则采用所有三种固定方法治疗（P = 0.002）。与接受EIN治疗的患者（22%；11/50）相比，接受MEF治疗（47%；9/19）和PO治疗（46%；6/13）的患者并发症发生率更高。在控制年龄、体重和骨折严重程度后，接受PO和MEF治疗的患者发生严重并发症的几率分别是接受EIN治疗患者的6.0倍和6.2倍（P = 0.01，P = 0.02）。其他骨折特征和疗效无显著差异。
尽管骨干骨折部位可能影响植入物选择，但三种固定方式（PO、EIN和MEF）的适应症相似。与PO和MEF相比，EIN并发症发生率更低，是小儿胫骨干骨折手术治疗的有力选择。
（1）对于骨骼未成熟胫骨干骨折的手术治疗，包括钢板内固定（PO）、弹性髓内钉固定（EIN）和多平面外固定（MEF），最佳植入物尚无明确共识。（2）在82例小儿胫骨干骨折患者中，大多数患者接受EIN治疗（61%；50/82），23%（19/82）接受MEF治疗，16%（13/82）接受PO治疗，各治疗组在开放性骨折（P = 0.96）或粉碎性骨折（P = 0.19）方面无差异。（3）骨折部位因治疗方法不同存在显著差异，中1/3骨折大多采用EIN治疗（77%；34/44），远1/3骨折则采用所有三种固定方法治疗（P = 0.002）。（4）与接受MEF治疗（47%；9/19）和PO治疗（46%；6/13）的患者相比，接受EIN治疗的患者（22%；11/50）并发症发生率更低。在控制年龄、体重和骨折严重程度后，接受PO和MEF治疗的患者发生严重并发症的几率分别是接受EIN治疗患者的6.0倍和6.2倍（P = 0.01，P = 0.02）。（5）尽管骨干骨折部位可能影响植入物选择，但三种固定方式的适应症相似，EIN并发症发生率更低，是小儿胫骨干骨折手术治疗的有力选择。
III级：病例对照研究或回顾性队列研究。
