Transphyseal Rigid Intramedullary Nailing in Pediatric Femoral and Tibial Fractures: A Systematic Review
Presenter Status
Medical Student
Abstract Type
Basic Research
Primary Mentor or Principal Investigator
Dr. Michael Benvenuti
Presentation Type
Poster
Start Date
20-5-2026 12:00 PM
End Date
20-5-2026 1:00 PM
Abstract Text
Background: Management of pediatric tibial and femoral shaft fractures presents a unique clinical challenge. With options ranging from non-operative management to rigid intramedullary nailing, decision making relies on several patient and fracture characteristics. Rigid intramedullary nailing in pediatric patients remains controversial, with concerns for growth disturbance as a result of physeal disruption. The incidence of growth arrest may be overestimated, but strong clinical research is lacking in this area.
Objectives/Goal: The goal of this study was to better characterize the safety profile of rigid intramedullary nail use in skeletally immature populations. A systematic review was performed to identify all available published data, with the hope to guide future surgical practice in pediatric long bone fractures.
Methods/Design: A systematic review was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was clearly defined as well as article inclusion and exclusion criteria. Searches of PubMed and EMBASE were performed using a tailored Boolean-based search strategy by two independent researchers. The design of this search was optimized using preliminary search terms, and with the help of medical librarians at the authors’ institutions. Articles were then screened by title/abstract, with final full-text review for remaining studies. Data collection, synthesis of results, and risk of bias analysis was performed for all included studies.
Results: Seven articles were included in the study after final review, including three animal studies and four human retrospective case series. Femoral shaft nailing was examined in four studies, with tibial shaft nailing analyzed in the remaining three. There was no significant growth arrest noted in any human study. Growth arrest was seen in two animal studies, with the most reliable predictive factor of eventual arrest being >7% physeal disruption during nail placement. The other study found evidence of growth arrest in sheep euthanized at 3 months (n=4), but no evidence of persistent growth arrest in sheep euthanized at 5 months (n=4), suggesting possible time dependent recovery. Other investigated variables including hardware removal, fat-grafting, and reamed technique did not have a significant effect on rates of growth disturbance.
Conclusions: Rigid intramedullary nailing has historically been avoided in pediatric and adolescent patients due to concerns for physeal damage and subsequent growth arrest. Analysis of the available data suggests that this risk is likely low in adolescent patients, with limited information from younger populations. Although current results are encouraging, larger prospective studies are needed to confirm these findings.
Disclosures: Artificial Intelligence (AI) was used during the production of this manuscript for grammatical edits and readability, but production of the manuscript content was original and performed by the authors including final search design and data collection.
Transphyseal Rigid Intramedullary Nailing in Pediatric Femoral and Tibial Fractures: A Systematic Review
Background: Management of pediatric tibial and femoral shaft fractures presents a unique clinical challenge. With options ranging from non-operative management to rigid intramedullary nailing, decision making relies on several patient and fracture characteristics. Rigid intramedullary nailing in pediatric patients remains controversial, with concerns for growth disturbance as a result of physeal disruption. The incidence of growth arrest may be overestimated, but strong clinical research is lacking in this area.
Objectives/Goal: The goal of this study was to better characterize the safety profile of rigid intramedullary nail use in skeletally immature populations. A systematic review was performed to identify all available published data, with the hope to guide future surgical practice in pediatric long bone fractures.
Methods/Design: A systematic review was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was clearly defined as well as article inclusion and exclusion criteria. Searches of PubMed and EMBASE were performed using a tailored Boolean-based search strategy by two independent researchers. The design of this search was optimized using preliminary search terms, and with the help of medical librarians at the authors’ institutions. Articles were then screened by title/abstract, with final full-text review for remaining studies. Data collection, synthesis of results, and risk of bias analysis was performed for all included studies.
Results: Seven articles were included in the study after final review, including three animal studies and four human retrospective case series. Femoral shaft nailing was examined in four studies, with tibial shaft nailing analyzed in the remaining three. There was no significant growth arrest noted in any human study. Growth arrest was seen in two animal studies, with the most reliable predictive factor of eventual arrest being >7% physeal disruption during nail placement. The other study found evidence of growth arrest in sheep euthanized at 3 months (n=4), but no evidence of persistent growth arrest in sheep euthanized at 5 months (n=4), suggesting possible time dependent recovery. Other investigated variables including hardware removal, fat-grafting, and reamed technique did not have a significant effect on rates of growth disturbance.
Conclusions: Rigid intramedullary nailing has historically been avoided in pediatric and adolescent patients due to concerns for physeal damage and subsequent growth arrest. Analysis of the available data suggests that this risk is likely low in adolescent patients, with limited information from younger populations. Although current results are encouraging, larger prospective studies are needed to confirm these findings.
Disclosures: Artificial Intelligence (AI) was used during the production of this manuscript for grammatical edits and readability, but production of the manuscript content was original and performed by the authors including final search design and data collection.
Comments
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Poster Board Number: 14