title: Intramedullary flexible nail fixation of unstable pediatric tibial diaphyseal fractures.
abstract: Flexible intramedullary nail fixation provides excellent fixation in children with unstable tibial shaft fractures, but few published series demonstrate the results and complications with this technique in children. A retrospective review of 19 patients was performed, as well as a biomechanical analysis of two implant configurations. Outcome measures included union rates, residual deformity, and complications. Union occurred in all cases. Five patients (26%) had complications. None required repeat operation. Two (11%) angular deformities (>/=10 degrees) occurred with the medial C and S construct, versus none with the double C. The C and S construct was more stable to mechanical testing with axial and torsional loading. Flexible intramedullary nail fixation is a straightforward technique that reliably produces good results. While the C and S construct was superior in biomechanical testing, the double C construct is more reliable and straightforward and remains by far the authors' preferred technique.
authors.affiliation: Department of Orthopedics, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Goodwin
authors.forename: Tracey
authors.initials: T
authors.lastname: Gaynor
authors.forename: Andrew
authors.initials: A
authors.lastname: Mahar
authors.forename: Richard
authors.initials: R
authors.lastname: Oka
authors.forename: François D
authors.initials: FD
authors.lastname: Lalonde
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D001858:Bone Nails; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome