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September 3, 2026Journal of the Pediatric Orthopaedic Society of North AmericaOpen Access

Lateral-Only Flexible Intramedullary Nailing for Pediatric Tibial Shaft Fractures: An Early Comparative Experience with a Novel Technique to Reduce Symptomatic Implant Prominence

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Authors

AMAlan Villegas MezaMAMatthew AllenBMBrendon C. Mitchell

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Overview

Retrospective cohort study reveals reduced symptomatic implant prominence with lateral-only flexible intramedullary nailing in pediatric tibial fractures, suggesting a viable alternative to...

Key Points

  • To compare symptomatic implant prominence and secondary clinical outcomes between lateral-only and standard medial-lateral flexible intramedullary nailing in pediatric patients with tibial shaft fractures.
  • Retrospective two-cohort study across two tertiary children's hospitals (2015–2024) analyzing 42 patients aged 5–16 years with tibial shaft fractures.
  • Patients received either lateral-only flexible nailing (n=13) or conventional medial-lateral fixation (n=29).
  • The primary endpoint was symptomatic implant prominence; secondary endpoints included operative duration, implant removal, and non-prominence complications.
  • Lateral-only fixation was associated with significantly less symptomatic implant prominence than medial-lateral fixation (8% vs. 66%; p < 0.001).
  • Implant removal occurred in 31% of lateral-only cases versus 55% of medial-lateral cases (p = 0.19), with operative times averaging 26 minutes shorter for the lateral-only approach (97 vs. 123 minutes; 95% CI −2 to 53; p = 0.063).
  • Non-prominence complications occurred in 23% (3 of 13) of lateral-only cases compared with 3% (1 of 29) of medial-lateral cases (p = 0.08).

Cite This Study

Meza et al. (2026) studied this question.

synapsesocial.com/papers/6a9935e5636c6408cfa7e7fehttps://doi.org/10.1016/j.jposna.2026.100440
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Flexible nailing: Pushing the indications for diametaphyseal lower-extremity fractures2024 · 4 citations
  2. 2Percutaneous Plating of the Distal Tibia and Fibula: Risk of Injury to the Saphenous and Superficial Peroneal Nerves2010 · 27 citations
  3. 3Elastic stable intramedullary nailing in paediatric diaphyseal forearm fractures – a retrospective analysis of 201 cases2024 · 10 citations
  4. 4The Importance of the Saphenous Nerve in Ankle Surgery2016 · 21 citations