Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients.

Abstract

To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on postoperative complications and iatrogenic changes in tibial slope due to anterior physeal arrest. Retrospective case series. A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center. Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen 42 A to C fractures between March 2009 and January 2024 with postoperative follow-up more than 1-year. The primary outcome was change in tibial slope after RIMN. Secondary outcomes included postoperative weight-bearing status and complications. Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month postoperative radiographs (mean 18.4 ± 12.7 months), there was no significant change from preoperative to postoperative tibial slope (80.0 ± 1.9 vs. 80.1 ± 1.6 degrees, P = 0.86). Time to achievement of full weight-bearing across the series averaged 45.4 ± 35.6 days. Five patients (14%) underwent hardware removal, and 89% of patients reported that they had returned to "normal" activity at the latest follow-up (mean 56.2 ± 42.5 months). This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated postoperative complications indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.