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Problems with Titanium Nails Used in Pediatric Tibial Fractures

Studies are ongoing to compare stainless steel with titanium nails (rods) used to treat broken bones. In this study, surgeons report on the results of titanium elastic nails for fractures of the tibia (shin bone). Sixty children ages five to 17 were included.

Titanium elastic nails can be bent before placing them in the bone to stabilize a fracture. Once inside the bone, they are a solid support while healing takes place. Complications can occur and are the subject of this study.

The authors reviewed the charts and X-rays of children with unstable tibial diaphyseal fractures over a seven year period of time. Diaphysis is the main shaft of the tibia.

All the children were treated with titanium elastic nails. Titanium is the alloy used to make the nails. Elastic refers to the fact that there is some give or bend to the bone. This allows the surgeon to shape the nail before inserting it into the bone.

Nail size selected depended on the child's age and size of the tibial bone shaft. In all but one case, two nails were used to stabilize the fractures. The nail was taken out when there was a solid fracture union formed. Each child was allowed to go back to his or her regular activities as tolerated.

The authors report a high rate of delayed healing and nonunions in their patients. Older children (ages 11 to 15) were most likely to have this problem. This is known to happen in adults who have tibial fractures. Children are more likely to have an uneventful course of healing. The results of this study were surprising.

Children who were put in a short leg walking cast to give the bone increased stability seemed to do better. Two children needed additional surgery. There was extra bone formation that the authors think was caused by too much motion at the fracture site during healing.

Titanium elastic nails are safe in children with stable or unstable bone fractures. However, there are some problems. Titanium may not give enough stability for tibial diaphyseal fractures. Although some studies report nail migration and infection, in this study lack of stability was the greatest problem.

References: J. Eric Gordon, M.D., et al. Complications After Titanium Elastic Nailing of Pediatric Tibial Fractures. In Journal of Pediatric Orthopaedics. June 2007. Vol. 27. No. 4. Pp. 442-446.

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