# Clinical and Radiological Outcomes of Titanium Elastic Intramedullary Nailing in Pediatric Tibial Shaft Fractures

## TL;DR

This study shows that titanium elastic nailing heals pediatric tibial fractures in about 12 weeks, with faster healing in older children.

## Contribution

The study provides new evidence on healing times for pediatric tibial fractures using titanium elastic nailing.

## Key findings

- Mean union time was 12.41 weeks for pediatric tibial shaft fractures treated with TEN.
- Older children (8-15 years) had significantly shorter union times (11.61 weeks) compared to younger children (13.08 weeks).

## Abstract

Background

Tibial shaft fractures are common injuries in children. Stable fractures are often managed non-operatively. Unstable fractures typically require surgical intervention. Titanium elastic intramedullary nailing (TEN) is a widely used minimally invasive technique. It provides stable fixation and promotes fracture healing through controlled micromotion. This study aimed to determine the mean union time for pediatric tibial shaft fractures treated with TEN.

Methods

We conducted a descriptive case series over three years. It included 68 children aged one to 15 years. All participants had closed, transverse tibial shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 42-A3). We excluded patients with open fractures, segmental patterns, or significant comorbidities. All patients underwent closed reduction and internal fixation with two pre-bent titanium elastic nails. The primary outcome was the mean duration to union. Union was assessed clinically by pain-free weight-bearing and radiologically by bridging callus on at least three cortices.

Results

The mean participant age was 8.03 years with a standard deviation of 2.16 years. There was a male predominance (n=40, 58.82%). The overall mean union time was 12.41 weeks with a standard deviation of 2.30 weeks. Stratification analysis showed a significantly shorter union time in older children aged eight to 15 years (n=31, 45.59%) compared to younger children aged one to seven years (n=37, 54.41%). The union times were 11.61 versus 13.08 weeks, respectively, with a p value of 0.008. We observed no significant differences in union time concerning gender, patient weight, or time from injury to surgery.

Conclusion

TEN is an effective and reliable method for managing unstable tibial shaft fractures in children. It results in predictable union with a relatively short healing time. This minimally invasive procedure should be considered a standard option in pediatric orthopedic care.