Publication:

Elastic stable intramedullary nailing for pediatric tibial shaft fractures: a prospective observational study of clinical, radiological and functional outcomes

Background Pediatric tibial shaft fractures are among the most common long-bone injuries in children. Although stable fractures can be managed conservatively, unstable or displaced fractures often require surgical stabilization. Elastic stable intramedullary nailing (ESIN) provides minimally invasive fixation while preserving fracture biology and allowing early mobilization. This study evaluated the clinical, radiological, and functional outcomes of ESIN in pediatric tibial shaft fractures.

Methods This prospective observational study included 40 children aged 3–15 years with closed or Gustilo–Anderson grade I open tibial shaft fractures treated with ESIN at a tertiary care centre between October 2023 and November 2025. Patients were followed for 12 months. Outcome measures included radiological union using the modified radiographic union score for tibial fractures (mRUST), pain using the visual analogue scale (VAS), knee and ankle range of motion (ROM), time to weight-bearing, alignment, complications, and functional outcome using Flynn's criteria.

Results The mean age was 10.7±2.9 years, and 72.5% of patients were male. Mean operative time was 60.5±9.5 minutes with mean blood loss of 20.8±7.3 ml. Radiological healing, pain, and functional outcomes improved significantly throughout follow-up (all p<0.001). Mean time to radiological union was 9.4±1.9 weeks, with full weight-bearing achieved at 10.7±2.1 weeks. At 12 months, 85% of patients had excellent and 15% had satisfactory outcomes according to Flynn's criteria. One patient (2.5%) developed a superficial wound infection; no non-union, malalignment, or significant limb-length discrepancy was observed.

Conclusions ESIN is a safe, effective, and minimally invasive treatment for pediatric tibial shaft fractures, providing reliable fracture union, excellent functional recovery, and a low complication rate.