Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients.

Objectives: To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on post-operative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.
Methods: Design: Retrospective case series.
Setting: 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.
Patient Selection Criteria: Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for OTA/AO 42 A to C fractures between March 2009 and January 2024 with post-operative follow-up more than 1-year.
Outcome Measures and Comparisons: The primary outcome was change in tibial slope after RIMN. Secondary outcomes included post-operative weight-bearing status and complications.
Results: Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month post-operative radiographs (mean 18.4 ± 12.7 months), there was no significant change from pre- to post-operative tibial slope (80.0 ± 1.9° vs 80.1 ± 1.6°, p=0.86). Time to achievement of full weightbearing across the series averaged 45.4 ± 35.6 days. Five (14%) of patients necessitated hardware removal, and 89% of patients reported they had returned to "normal" activity at latest follow-up (mean 56.2 ± 42.5 months).
Conclusions: 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 post-operative 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.
Level of Evidence: IV.
Competing Interests: Potential Conflicts of Interest and Funding Sources: Jessica L. Koshinski BS: None are declared. Joshua T. Bram MD: None are declared. Preston W. Gross BS: None are declared. Sarah H. Hine MD: None are declared. Daniel S. Hayes BS: None are declared. Peter D. Fabricant MD, MPH: BICMD, Inc. (Paid consultant), Clinical Orthopaedics and Related Research (Editorial or governing board), HS2, LLC (Stock or stock Options), HSS ASC Development Network, LLC (Stock or stock options), Joint Effort Administrative Services Organization, LLC (Stock or stock options), Osso VR (Stock or stock options) Mark A. Seeley MD: Consultant for OrthoPediatrics.
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