title: Open unstable metaphyseo-diaphyseal fractures of the tibia in adolescents: treatment by flexible intramedullary nails augmented by external fixator.
abstract: BACKGROUND
  The treatment of open and unstable metaphyseo-diaphyseal fractures of the tibia in adolescents is challenging. It is important to choose a fixation method that can maintain alignment, allow wound care and not violate the growth plate. The aim of this work was to evaluate the efficacy of using flexible intramedullary nails (FIN) augmented by external fixator (EF) in the management of such fractures.
  
  
  METHODS
  A total of 26 males, with a mean age of 14.08 years and average body weight of 49.8 kg, presented with open metaphyseo-diaphyseal tibial fractures. All cases were treated using FIN augmented by mono-lateral EF. The fractures were located at the upper third in 17 cases and at the lower third in nine cases. The fracture pattern was spiral in eight cases, oblique in seven and multi-fragmentary in 11. The results were evaluated according to the scoring system for femoral TENs.
  
  
  RESULTS
  All fractures united primarily after an average eight to 12 weeks with no evident angular deformity or limb-length discrepancy. None of the cases required cast immobilization or revision procedure. Twenty patients had excellent results, six patients showed good results and none had poor results. Fracture characteristics as well as patients' characteristics had no statistically significant effect (p > 0.005) on the final end results.
  
  
  CONCLUSIONS
  The use of FIN augmented by EF is a good alternative in the management of open metaphyseo-diaphyseal tibial fractures in adolescents. This fixation provides more stability, allows easy access to the wound and early patients' ambulation.
authors.affiliation: Orthopaedic Department, Tanta University, Tanta, Egypt, ashraf19970@yahoo.com.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Atef
authors.forename: Ahmad
authors.initials: A
authors.lastname: El Tantawy
mesh_terms: D000293:Adolescent; D001858:Bone Nails / Q000009:adverse effects*; D018483:Diaphyses / Q000601:surgery; D016267:External Fixators / Q000009:adverse effects*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D005597:Fractures, Open / Q000601:surgery*; D006132:Growth Plate / Q000601:surgery; D006801:Humans; D008297:Male; D012086:Reoperation; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*