Complementary Cast Immobilization Is Not Necessary after Intramedullary Fixation of Unstable Tibial Shaft Fractures in Pediatric Patients

Retrospective comparison of pediatric tibial shaft fractures treated with elastic stable intramedullary nails (ESIN) alone versus ESIN plus cast immobilization found no significant difference in outcomes. Both groups achieved union without surgical correction, though the no-cast group had slightly higher rates of early malalignment requiring outpatient wedging cast adjustment.