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

Introduction Some surgeons believe that patients with benefit of additional stability provided by a cast after the treatment of pediatric tibia fractures with elastic stable intramedullary nails. Whereas in some institutions, complementary immobilization is not used after elastic stable intramedullary nails (ESIN). At our trauma center, half of our surgeons treat tibia fractures with ESIN alone and half use complementary casting. We hypothesized that our outcomes are the same between the two groups.

Materials and Methods Patients with tibia shaft fractures were treated in accordance with the preference of attending surgeon with one of two initial interventions: ESIN or ESIN and complementary immobilization with long-leg cast. Outcomes of these two treatment groups were compared. The main outcome variables were redisplacement and angulation at the time of union.

Results Treatment groups did not differ significantly on sex, type of fracture, or on age. Four patients developed a varus malalignment exceeding 10 degrees during first 2 weeks of follow-up and were corrected in the outpatient clinic by application of wedging cast. Three out the four were originally in the no cast group (p = 0.3). Final angulation and time to union were higher in no cast group, but there was no statistical significance (p = 0.5 and p = 0.4).

Conclusion This study showed good outcomes in both treatment methods without any surgical deformity correction after operative treatment. Though we could not find any advantages in complementary casting.