Double Proximal Medial Entry Technique in Elastic Stable Intramedullary Nailing for Pediatric Tibial Shaft Fractures

Background: Tibial shaft fractures are one of the most common fractures affecting the pediatric age group. Conservative management by closed reduction and above-knee casting is still the standard treatment for these injuries. When surgical fixation is indicated, elastic stable intramedullary nailing (ESIN) has multiple advantages over other surgical options, such as open reduction and internal fixation or external fixation. However, ESIN use is not without complications. The standard technique of ESIN tibial fracture fixation entails medial and lateral entry points. In this study, we describe a new technique of double proximal medial entry for ESIN in pediatric tibial shaft fracturese.Aim: This study aimed to assess the functional and radiological outcomes of double proximal medial entry for ESIN in pediatric tibial shaft fractures.Patients and Methods: This prospective case series was conducted at Cairo University Hospitals between November 2021 to October 2022. Inclusion criteria included skeletally immature patients with tibial shaft fractures indicated for surgical treatment. Cases with skeletal dysplasia, osteogenesis imperfecta, pathological fractures, and comminuted fractures were excluded from the study. Fixation with ESIN using double proximal medial entry was done for all cases. Regular clinical and radiological follow-ups were done. Functional outcome was assessed using Flynn’s outcome scoring system. Bone union was defined as the bridging of at least three cortices.Results: The study included 19 patients with an average age of 9.9 years (range, 6–14 years). Seventeen were male, and two were females. The tibial fracture was open in seven cases (four Gustilo 1 and three Gustilo 2 classifications) and closed in 12 cases. The mean operative time was 34 min. Bone union was achieved after a mean of 10 weeks. The statistically significant earlier union was achieved in closed fracture cases compared to open fractures. At the final follow-up, the mean coronal plane angulation was 3 degrees, while the mean sagittal plane angulation was 2 degrees. Two patients had mild skin irritation, and one patient had a superficial infection.Conclusions: The double proximal medial entry technique for ESIN in managing pediatric tibial shaft fractures is a reliable method, offering good functional and radiological outcomes comparable to the standard medial and lateral entry technique.