The Effect of Transphyseal Rigid Tibial Nailing on Proximal Tibial Morphology in Pediatric Patients With at Least 1 Year of Growth Remaining

Introduction: Tibial shaft fractures are common in the pediatric population. As patients approach skeletal maturity, rigid intramedullary nailing of these fractures is a potentially advantageous option, allowing rigid fixation and earlier mobilization and weight-bearing. However, potential injury to the open proximal tibial physis in patients with remaining growth remains a concern. This study sought to determine the rate of growth disturbance following rigid, transphyseal tibial nailing of tibial shaft fractures in patients with open physes. Methods: This was a retrospective study of skeletally immature patients who were treated with transphyseal nailing of a tibial shaft fracture. Included patients had at least 1 year of growth remaining, as determined by the Modified Fels Skeletal Maturity System, and at least 1 year of follow-up. Growth disturbance was determined by a change in posterior tibial slope or medial proximal tibial angle on radiographs obtained at the time of injury as compared with radiographs at final follow-up. Results: A total of 20 patients were included in the study. The mean chronological age of the cohort was 14.5 years (SD=1.47, range: 12 to 17 y) at the time of injury. The mean skeletal age at the time of injury in female patients was 12.6 years (SD=0.4, range: 12.0 to 13.0) and in males, 14.4 years (SD=0.7, range: 12.5 to 15.0). The cohort had a mean of 1.51 years of growth remaining (SD=0.6, range: 1 to 3.5 y). There was no significant change in the mean posterior tibial slope or medial proximal tibial angle between injury and final radiographs ( P =0.467, 0.906, respectively). Two patients developed a decrease in posterior tibial slope angle (flattening of slope) of greater than 3 degrees (3.9 and 6.7 degrees). Conclusions: Rigid transphyseal nailing of pediatric tibial shaft fractures in patients with open physes who are approaching maturity remains a safe treatment option; however, when more than 1 year of growth remains, surgeons must carefully monitor patients for the development of angular deformity at the knee.