Purpose: Telescoping intramedullary rods have transformed the management of long bone deformity and fragility fractures in children, yet complications and revision surgery remain common. This systematic review synthesizes outcomes across telescoping systems to evaluate complication and revision rates, telescoping success, and design evolution to guide implant selection and surgical decision-making in pediatric orthopedics. Methods: A search was conducted through July 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting outcomes of telescoping rods in pediatric patients were included. Due to heterogeneity, results were synthesized descriptively and presented as weighted means per operated bone. Results: Thirty-three studies (861 patients; 2054 rods) were included. Weighted mean complication and revision rates were 49.6% and 25.7% for Bailey-Dubow rods, 61.1% and 24.5% for Sheffield rods, 37.1% and 30.5% for Fassier-Duval rods, 14.9% and 9.0% for corkscrew-locking rods, and 46.7% and 6.7% for distal-female rods. Telescoping success was 48% for Bailey-Dubow, 74% for Fassier-Duval, 94% for corkscrew, and 100% for distal-female designs. Variation in follow-up duration and definitions of complications contributed to differences in reported rates. Conclusions: Modern telescoping rods have reduced migration and mechanical failure compared with earlier designs, yet complication and revision rates remain substantial. Newer systems show encouraging early results but require longer follow-up for validation. Differences in bone anatomy and biomechanics strongly influence implant performance, underscoring the need to tailor rod selection to individual bones. Significance: This review consolidates published complication and revision rates across telescoping rod designs, establishing a foundation for comparison as newer implants are introduced and long-term outcome data become available. Level of Evidence: III.
Mounsef et al. (Tue,) studied this question.