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Intramedullary nailing versus external fixation for pediatric tibial fractures: a systematic review and meta-analysis of functional outcomes and complications

orthopedics
pediatrics

Abstract

Background: In pediatric tibial fracture treatment, surgical methods such as Elastic Stable Intramedullary Nailing (ESIN) and External Fixation (EF) are typically selected based on injury mechanism. A systematic comparison of their clinical outcomes is warranted. This study evaluates differences in postoperative efficacy and complications between ESIN and EF, aiming to improve prognostic assessment and optimize clinical management.
Methods: A systematic search of online databases identified studies comparing ESIN and EF in pediatric tibial fractures with reported clinical outcomes. Meta-analysis was conducted on bone growth-related indicators (healing time, malunion, delayed union, reoperation rate) and other complications (pin tract infection, skin lesions, compartment syndrome).
Results: Eight studies involving 364 patients (221 ESIN, 143 EF) were included. ESIN showed significantly shorter healing time (MD: - 5.75 days; 95% CI: - 8.76 to - 2.75; P = 0.0002), lower reoperation rate (OR: 0.27; 95% CI: 0.13–0.56; P = 0.0003), and reduced malunion incidence (OR: 0.26; 95% CI: 0.11–0.63; P = 0.003). Delayed union was more frequent in the EF group but not statistically significant (OR: 0.80; 95% CI: 0.26–2.44; P = 0.70). Overall complication rate was lower with ESIN (OR: 0.39; 95% CI: 0.21–0.71; P = 0.002).
Conclusion: Both ESIN and EF are effective for pediatric tibial fractures, each with specific indications. ESIN demonstrates advantages in bone healing and complication rates, while EF remains essential in complex or open fractures.
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