ESIN-Osteosynthese bei dislozierten Unterschenkelschaftfrakturen: Fehler- und Komplikationsanalyse

Literature offers divergent data concerning the operative treatment of tibial and complete shaft fractures of the lower leg in children with elastic stable intramedullary nailing regarding postoperative complication rate, corrective procedures or supportive casts. Target of this study was to evaluate intra- and postoperative complications of stabilized shaft fractures of the lower leg and tibia (LiLa classification 4.2.S.3.2.) with elastic stable intramedullary nailing (ESIN) in children and adolescents (age 1 to 16 years). In particular we were interested in technical problems, misalignment and long-term results regarding to the functional outcome, which was measured by clinical examination and by using the MERCHANT and DIETZ score. During a 7-year period (March 2002 to February 2009) 131 children with a shaft fracture of the lower leg were treated in our department: 95 non-operatively, 6 with external fixation and 30 children with elastic stable intramedullary nailing. In 13 patients an additional cast was used. 8 peri-and postoperative complications (one compartment syndrome, one infection, one redislocation after fall) as well as five corrective procedures occurred. A technical error during implementation of the nailing occurred five times, of these twice corkscrew phenomen. Postoperative clinical examination showed no limb length discrepancy greater than 1.0 cm or misalignment greater than 10°. Functional outcome was good in all patients. In the operative treatment of shaft fractures of the lower leg with elastic stable intramedullary nailing sometimes an additional cast is needed due to instabilities. Axial deviations are more often associated with technical errors. To avoid redo operations and an additional cast therapy as well as achieving faster weight bearing, the elastic in- trameduilary nailing can be improved by the implantation of a third nail. Further biomechanical and clinical studies have to be done concerning the problems mentioned above.