Superior Functional Outcomes and Faster Healing in Elastic Intramedullary Nails Compared with Minimal Invasive Plate Osteosynthesis for Adolescent Tibial Fractures

Abstract

Background: To evaluate the effectiveness and results of elastic stable intramedullary nailing (ESIN) compared with minimally invasive plate osteosynthesis (MIPO) in managing adolescent diaphyseal tibial fractures.Patients and Methods: A randomized prospective clinical trial was carried out involving 40 adolescent patients aged 10–19 years with diaphyseal or closed extra-articular metaphyseal tibial fractures. Patients were randomized into two groups: group A (n= 20) treated with MIPO and group B (n= 20) treated with ESIN. Operative time, intraoperative blood loss, hospital stay duration, radiographic healing assessed by the Radiographic Union Score for Tibial fractures, and functional outcomes based on Lam SJ’s criteria were evaluated over a 12-month follow-up period.Results: Group B (ESIN) demonstrated significantly shorter operative times (mean 65.0±4.94min) compared with group A (MIPO) (mean 75.5±11.29min, P<0.001). Group B experienced significantly reduced intraoperative blood loss. (66.00±10.46cc) than in group A (171.50±20.33cc, P<0.001). Radiological assessment showed that group B achieved better healing at 2, 4, and 6 months postoperatively (P±0.001). However, at 12 months, the two groups demonstrated no significant differences (P= 0.178). Functional outcomes were better in Group B, with a higher proportion of excellent outcomes (55vs. 30%, P= 0.050). Postoperative complications were minimal in both groups, with transient anterior knee pain in group B and superficial infections in group A, all of which resolved with appropriate management.Conclusions: ESIN offers advantages over MIPO in terms of shorter operative time, reduced intraoperative bleeding, and faster early bone healing, with a trend toward better early functional outcomes. However, by 12 months, both techniques achieve comparable radiological and functional results. Consequently, ESIN may be preferable when minimizing operative time and blood loss is a priority, while recognizing that either method ultimately provides similarly effective long-term outcomes.