Suprapatellar Tibial Nailing in Skeletally Immature Patients: A Case Series

Introduction: Tibial shaft fractures are common pediatric injuries. Rigid intramedullary nails (RIMN) are widely used for the fixation of complex tibial shaft fractures in skeletally mature individuals, but their safety is debated in patients with open physes. There has been growing support for the use of RIMN fixation in pediatric patients due to the stability and rapid return to weight-bearing activities they offer. In this study, we evaluate the utility and safety of suprapatellar RIMN fixation in skeletally immature children with tibial shaft fractures. Materials and Methods: This retrospective case series includes seven skeletally immature patients treated with suprapatellar RIMN fixation of tibial shaft fractures at a single level one trauma center between May 1, 2009, and May 1, 2024. The primary outcome of interest was clinical signs of iatrogenic growth arrest. Secondary outcomes of interest included post-operative complications and time to full weight bearing (FWB), union, and sport. Results: The mean age at the time of operation was 13.7 years (range: 12-15) and the mean follow-up time was 14.21 months (range: 6-26.5). We observed no clinical evidence of iatrogenic growth arrest or limb deformity post-operatively. The mean time to union was 24.17 weeks. On average, patients returned to FWB and full activity/sport at 10.33 and 22.67 weeks, respectively. The majority of patients (n = 5) did not require hardware removal with the exception of one patient who developed a deep tissue infection and another with delayed union of an associated fibula fracture. Conclusion: In a series of seven skeletally immature children, suprapatellar RIMN fixation of tibial shaft fractures was not associated with iatrogenic growth arrest. Benefits of this fixation technique include an expedited return to weight-bearing activity and sport.