To Manage Middle Or Distal Segment Fracture Of Tibiae In Child—compare Ilizarov With Nailing

Objective: To compare indications,operation technique,clinical curative effect and complications of the treatment of middle or distal pediatric tibial fractures between Ilizarov external fixator and flexible intramedullary nail,and to provide a suit of methods to cure these fractures.Methods: We reviewed the records of 65 patients with middle or distal tibial fractures treated with surgery in our hospital.In this descriptive analytic study,65 patients(including 50 boys and 15 girls)were treated with either Ilizarov external fixator(A group,n=22)or flexible intramedullary nail(B group,n=43)during 2013~2016.Mean age at the time of surgery was 8.6 years(range between 2 and 14 years)and the average follow-time was 29 months(range between 8 and 48 months).The results were evaluated considering time duration in hospitalization,operation,bone union,weight bearing and joint function.The clinical results were graded according to the Johner-Wruhs criteria.Results: The A group and the B group were similar in terms of mean age,sex distribution and injury mechanism.There was some difference in the injured tibia side which didn't affect the final outcome.The mean duration of the hospitalization between the A group(13.6±2.8d)and B group(9.7±3.1d)was significant difference(P<0.05).The mean duration of the operative procedure between the A group(89.1±31.0min)and B group(56.0±17.6min)was significant difference(P<0.05).There was significant difference(P<0.05)in weight bearing time between A group(2.1±0.9w)and B group(5.8±1.3w).There was also significant difference(P<0.05)in bone union time between A group(9.7±2.4w)and B group(12.1±2.7w).The fixation remove time between A group(100±19d)and B group(248±60d)has significant difference(P<0.05).According to the Johner-Wruhs criteria,there were no significant differences between the two groups.In A group,21(95.5%)patients had a good result and 40(93%)patients had a good result in B group.Conclusions: There was no significant difference in the clinical result of the Ilizarov external fixator and the flexible intramedullary nail for the treatment of patients with middle or distal pediatric tibial fractures,including the complications between the two groups.However,there were advantages such as mini-invasive,earlier time of weight bearing,shorter time of bone union and removing fixture more convenient in the Ilizarov external fixator group.We think the Ilizarov external fixation is the better treatment for patients with middle or distal pediatric tibial fractures,especially for open fractures and severely comminuted fractures.