Clinical and Radiographic Outcomes of ESIN, Plate, and K-Wire Fixation in Pediatric Tibial DDMJ Fractures: A Retrospective Comparative Study

<b>Background:</b> Tibial distal diaphyseal-metaphyseal junction (DDMJ) fractures are rare in children and pose therapeutic challenges due to their morphology and risk of displacement. This study compared the clinical, radiological, and economic outcomes of elastic stable intramedullary nailing (ESIN), plate fixation, and Kirschner wire (K-wire) fixation. <b>Methods:</b> A retrospective review was conducted on 64 patients (6-15 years) treated between 2014 and 2023. Patients were grouped according to fixation method. Demographic, operative, radiographic, functional (AOFAS), complication, and cost data were analyzed. <b>Results:</b> The K-wire group, plate group, and ESIN group consisted of 27, 19, and 18 patients, respectively. The mean follow-up duration was 18.03 ± 6.87 months. Of the patients, 38 were male and 26 were female. Concomitant fibula fractures were present in 43 patients and were not present in 21 patients. AOFAS scores were highest in the plate group at the 4th month, while they were similar in all groups in the subsequent follow-ups. The costliest method was plate (2517.64 ± 104.83 $) (<i>p</i> = 0.001). <b>Conclusions:</b> All three fixation methods provided satisfactory long-term outcomes. Plate fixation offers faster early recovery but at higher cost and risk of soft-tissue complications; ESIN balances stability and invasiveness; K-wire is economical but less stable. Treatment choice should be individualized according to fracture pattern, patient factors, and resource availability.