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The technique has a higher rate of union than casting alone
3%
44/1722
The technique in contraindicated for patients >50kg
24%
421/1722
The patient may require a period of casting
28%
487/1722
The technique should be avoided in open fractures
1%
10/1722
Both 1 and 3
43%
748/1722
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A period of casting is generally indicated following elastic nailing of a tibia fracture. Tibial shaft fractures in the pediatric population are a relatively common injury, accounting for approximately 15% of all pediatric fractures. The treatment for these fractures can be operative or non-operative, with successful results in each method. The determination of treatment methodology should take into account both patient and fracture specific characteristics. When elastic nailing is chosen as the treatment option, a period of cast or splint immobilization is often recommended to decrease the risk of malunion/nonunion. Casting may aid in the maintenance of alignment and rotation, especially in the more unstable fracture types, by improving the stability of the construct before healing has taken place. Gordon et al. reviewed 60 pediatric tibial shaft fractures treated with flexible intramedullary fixation. They reported overall good results but noted an 11% delayed union rate, which tended to occur more frequently in the adolescent population (with an average age of 14). They concluded that treating pediatric tibial shaft fractures with flexible nailing is effective but has a delayed rate of healing in older patients. Srivastava et al. retrospectively reviewed 24 tibial shaft fractures treated with elastic nailing, 16 of which were open injuries. They found that the average time to union was similar for both the open and closed injury groups, with an average time to union between 20-21 weeks. They concluded that elastic nailing is an overall effective treatment option. Figure A is a lateral XR of a skeletally immature left leg with tibia and fibula fractures. Incorrect Answers: Answer 1: The union rates for casting and elastic nailing are equivalent; the main difference between the two techniques is that casting alone requires a longer period of immobilization. Answer 2: Unlike femur fractures, there is no relative contraindication to elastic nailing in patients weighing >50kg. Answer 4: Performing elastic nailing in open fractures is considered acceptable.
1.8
(14)
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