title: Titanium elastic nails for pediatric tibial shaft fractures.
abstract: OBJECTIVE
  The purpose of our study was to investigate the safety and efficacy of elastic stable intramedullary nailing for unstable pediatric tibial shaft fractures using titanium elastic nails (TENs). To our knowledge, this is the largest series reported in the literature of this specific fixation technique.
  
  
  METHODS
  We reviewed all children with tibial shaft fractures treated operatively at our tertiary care children's hospital to find those patients who underwent fixation with TENs. Between 1998 and 2005, we identified 19 consecutive patients who satisfied inclusion criteria. The average age of the patients in our series was 12.2 years (range 7.2-16 years), and mean follow-up was 15.7 months (range 6-28 months). Patient charts and radiographs were retrospectively reviewed to gather the clinical data. Outcomes were classified as excellent, satisfactory, or poor according to the Flynn classification for flexible nail fixation.
  
  
  RESULTS
  All patients achieved complete healing at a mean of 11.0 weeks (range 6-18 weeks). At final follow-up, mean angulation was 2 degrees (range 0 degrees -6 degrees ) in the sagittal plane and 3 degrees in the coronal plane (range 0 degrees -9 degrees ). Five patients (26%) complained of irritation at the nail entry site; there were no leg length discrepancies or physeal arrests as a result of treatment. Two patients required remanipulation after the index procedure to maintain adequate alignment. According to the Flynn classification, we had 12 excellent, six satisfactory, and one poor result.
  
  
  CONCLUSIONS
  Although the indications for operative fixation of pediatric tibial shaft fractures are rare, occasionally surgical treatment is warranted. Based on our results, elastic stable intramedullary nailing with titanium elastic nails is an effective surgical technique which allows rapid healing of tibial shaft fractures with an acceptable rate of complications.
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Wood Building, 2nd Floor, 34th and Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar
authors.forename: Kristofer J
authors.initials: KJ
authors.lastname: Jones
authors.forename: B
authors.initials: B
authors.lastname: David Horn
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wells