Submuscular Plating Versus Elastic Intramedullary Nailing in Children with Femoral Shaft Fracture; a systematic review and meta-analysis

IntroductionElastic stable intramedullary nailing (ESIN) is currently the technique of choice for pediatric femoral fractures. Submuscular plating (SMP) allows reliable healing associated with an early range of motion. The following systematic review and meta-analysis was carried out to reveal the functional and surgical outcomes of SMP and ESIN for fixation of pediatric femoral fractures and to aid in the decision-making processes for those who perform these procedures.MethodsAn extensive systematic literature review was implemented from inception to 23 February 2022. All clinical studies included had patients that were younger than 18 years old with femoral shaft fractures that compared outcomes between SMP and ESIN. Studies including patients with pathological fractures, closed femoral physis, multiple fractures, or refractures were excluded.ResultsThis meta-analysis included six articles encompassing 568 patients. Of them, 206 patients were treated with SMP, while 362 were subjected to ESIN procedure. There was significantly more blood loss among patients treated with SMP (MD -45.45; 95% −61.62, −29.27; p < 0.001). The risk of postoperative adverse surgical events was significantly higher among patients subjected to the ESIN (RR 2.97 19.5; 95% 1.27, 6.98; p = 0.01). The mean hospital stay was significantly shorter among patients subjected to ESIN (SMD -1.47; 95% −2.43, −0.51; p = 0.003). Patients subjected to SMP showed significantly more EFOs when comparing Flynn Scores (OR 0.24; 95% 0.09, 0.64; p = 0.004). There was no significant difference between SMP and ESIN regarding the mean operation time, limb length discrepancy, and mean time to union.ConclusionsChildren with femoral shaft fractures can be managed effectively and safely with SMP. There was a similar surgical outcome between SMP and ESIN, but SMP had more EFOs. While SMP was associated with a low risk of postoperative adverse surgical events, it was associated with a more significant blood loss and prolonged hospital stays.     

Elastic stable intramedullary nailing in pediatric femur and lower leg shaft fractures: intraoperative radiation load

BACKGROUND: Elastic stable intramedullary nailing (ESIN) is currently the therapy of choice in unstable, transverse and short oblique femoral and tibial-fibular shaft fractures in childhood and adolescence. As with every intramedullary technique, it requires a greater intraoperative reliance on radiological imaging. Literature concerning intraoperative radiation load in ESIN is rare, results having a wide range from less than 1 minute to more than 15 minutes. METHODS: We performed a retrospective analysis of 53 femoral and 24 tibial shaft fractures. In addition, image intensifier times of several steps of the operative procedure in 10 femoral shaft fractures were evaluated prospectively. RESULTS: The average radiation time in femoral fractures was 70.3 (range, 12-193) seconds, in tibial shaft fractures, 42.4 (range, 16-108) seconds. The prospective analysis of femur shaft fractures was able to show the most intense use of imaging during fracture passage (43.2%) and placement of the nail tips (26.6%). Image intensifier times in educational operations were not significantly higher than in operations performed by experienced surgeons. CONCLUSIONS: The actual intraoperative radiation load is influenced by bone mass and soft tissue coverage. Surgeons are able to reduce it only by decreasing the fluoroscopy time. According to our results, image intensifier time should not exceed 3 minutes in ESIN of femoral shaft fractures and 2 minutes in ESIN of lower-leg fractures. Low intraoperative radiation times are a mark of quality with respect to the interests of patients, surgeons, and operation theater staff.     

Femoral shaft fractures in childrenElastic stable intramedullary nailing in 31 cases

We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4–11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children clinically after median 1.5 (1–3) years. Their median hospital stay was 6 (2–20) days. All fractures were radiographically united at a median of 7 (5–9) weeks. The nails were removed in 29 children after a median of 22 (6–38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age.     

Femoral shaft fractures in children

We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4-11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children clinically after median 1.5 (1-3) years. Their median hospital stay was 6 (2-20) days. All fractures were radiographically united at a median of 7 (5-9) weeks. The nails were removed in 29 children after a median of 22 (6-38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age.     

Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases

We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4-11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children clinically after median 1.5 (1-3) years. Their median hospital stay was 6 (2-20) days. All fractures were radiographically united at a median of 7 (5-9) weeks. The nails were removed in 29 children after a median of 22 (6-38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age.     

Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

Objective: Studies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures.Methods: Totally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation.Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up.Results: ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore,DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group.Conclusion: ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results,restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.     

Results of femoral shaft fractures in childhood in relation to different treatment modalities

The clinical and radiological results of femoral shaft fractures in childhood were evaluated and compared in relation to different treatment modalities. One hundred and one children (mean age 5+/-0,4 years) were treated between 1990 to 1999. 38% of the patients were treated conservatively (mean age 2,2+/-0,5 years), 32% of the patients (mean age 6+/-0,5 years) were treated by external fixation, 17% were treated with elastic stable intramedullary nailing (ESIN, mean age 5,6+/-0,8 years) and 12% underwent other internal fixation procedures. The duration of hospital stay was significantly longer in the conservative treatment group (18+/-1,6 days) than in the external fixator (12+/-1,2 days) as well as in the ESIN group (8+/-0,9 days). Radiological controls revealed a significantly better reduction of the fracture by operative procedures (external fixator,ESIN) as compared to conservative management. Complications, i.e. secondary dislocation or infection, occurred in 25% of patients in the external fixator group,6% of the ESIN patients, and in 10% of the conservatively treated patients. Late complications,i.e.weight bearing dependent pain or hypertrophic scarring,were developed in both the conservative treatment group (4%) and in the external fixator group (19%); however,no late complications were seen in the ESIN group. While each method examined is known to be suitable for treatment of femoral shaft fractures in childhood,each has defined indications. Also there is a limited possibility of fracture reduction in conservative treatment this method is indicated in younger children (<4 years) where spontaneous bone remodelling is likely. For older children the ESIN method showed a low rate of complications and demonstrates the best long term results. When ESIN is not possible because of local soft tissue damage,additional injuries,or in complex fractures, the external fixator proved to be an alternative treatment for femoral shaft fractures.     

Displaced tibia shaft fractures in children treated by elastic stable intramedullary nailing: results and complications in children weighing 50 kg (110 lb) or more

The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibia shaft fractures in children weighing 50 kg (110 lb) or more treated by elastic stable intramedullary nailing (ESIN). Translation, sagittal and coronal angulations were assessed on plain radiographs in all the patients. Twenty-six out of 106 patients met the inclusion criteria. The average patient age at the time of injury was 13.5 ± 1.3 years (range 11.3–16.1). The mean patient weight was 57 ± 8 kg (range 50–80). This study demonstrates that the use of ESIN for displaced tibia shaft fractures in children and adolescents weighing 50 kg (110 lb) or more, or older than 13 years of age, is not contraindicated. In contrast to data in femoral shaft fractures, we did not find poorer outcomes in older or heavier patients. No correlation between nail size/medullary canal diameter ratio and outcome was observed.     

Untere Extremität: die kindliche Schaftfraktur

Fractures of the lower extremities in children and adolescents are common injuries and the lower leg is more often affected than the upper leg. There are many more recommendations for the treatment of femoral shaft fractures than for treatment of lower leg shaft fractures. Femoral shaft fractures in young children are the domain of conservative treatment. For the upper and lower leg, elastic stable intramedullary nailing (ESIN) is frequently used as the operative procedure up to a body weight of 50kg; however, plate osteosynthesis represents a serious alternative. The advantages of ESIN are the small access route and more rapid load-bearing. For simple transverse fractures the intramedullary stabilization is clearly superior. The disadvantage of ESIN is the high intraoperative radiation exposure. Plate osteosynthesis can also be carried out in a minimally invasive way and longer areas of fragmentation can be effectively bridged.     

Functional outcome of ipsilateral intertrochanteric and femoral shaft fractures

OBJECTIVES: The purpose of this study was to compare the functional outcome of patients with ipsilateral intertrochanteric and femoral shaft fractures treated with a reconstruction nail versus a sliding hip screw and retrograde nail. DESIGN: Retrospective cohort study. SETTING: Two level 1 trauma centers. PARTICIPANTS: Twenty-six patients with ipsilateral intertrochanteric and femoral shaft fractures treated between 1993 and 2003 with a reconstruction nail (n=13) or with a sliding hip screw and retrograde nail (n=13). INTERVENTION: Internal fixation with a reconstruction nail or a sliding hip screw and retrograde nail. MAIN OUTCOME MEASUREMENTS: Functional outcome was measured using the Short Form-36 (SF-36), Short Musculoskeletal Functional Assessment (SMFA), and Lower Extremity Functional Scale (LEFS). RESULTS: The average time to follow-up was 49.6 months. Functional outcome was significantly better in the sliding hip screw with retrograde nail group for the role emotional (P=0.001) and mental component scores (P=0.016) of the SF-36. This group also scored better on the LEFS, although not reaching statistical significance (P=0.099). CONCLUSIONS: For most outcome measures, no significant differences in functional outcome scores were observed between the 2 treatment groups. The results of this study suggest the need for a randomized controlled trial with a larger sample size to more definitively compare the 2 fixation constructs.     

ESIN in Femur Fractures

Abstract Background and Purpose: Elastic stable intramedullary nailing (ESIN) is gaining increasing popularity, but studies with high case loads are rare. It was the aim of four experienced pediatric trauma centers to give an update of indications for ESIN, postoperative management, and complications. Patients and Methods: Data of the last 100 ESIN cases of each department before June 30, 2003 were collected by reviewing the charts and X-rays. Among these 400 collected ESINs 65 femoral shaft fractures (16%) were found. The patients age ranged between 23/4 and 151/4 years. The middle third of the shaft was affected 42 times (65%), 13 fractures (20%) were in the proximal third of the diaphysis, and ten (15%) in the distal part of the femur, five dia- and five metaphyseal. Mainly transverse fractures were treated (52%), followed by 38% oblique or spiral fractures and 10% wedge or comminuted fractures. Two open reductions were required. Median hospitalization time was 6 days. Nails were extracted after a mean of 178 days. Results: Six skin irritations (wound infections, hematoma, seroma), one patient with myositis ossificans and one with constant pain at too long nail end were found. Three cosmetically relevant scarrings were observed during follow-up. Relevant axial deviations at fracture healing in two and shortening in one fracture could be seen, all caused by technical failure. Conclusion: ESIN meets all demands for an optimal fracture healing in children. Still, a considerable percentage of complications is observed, mainly caused by the surgeon himself, which can be avoided by exact indication and technique. Postoperative management has yet to be standardized.     

Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial

Purpose: Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures. Methods: The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria. Results: Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group. Conclusion: Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.     

Konservative Behandlung der isolierten Oberschenkelfraktur im Kindesalter

The principles of treatment for fractures of the femoral shaft in children include conservative and operative management. Traditionally, these fractures have been treated conservatively with skeletal traction. More frequent consideration is being given to the psychological and economical outcome. At what age of the patient surgery can be performed is still open to debate. From 1988 to 1999, 52 children with closed femoral shaft fractures were treated conservatively in the Klinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie der Universität Göttingen (until 1994 Klinik für Allgemeinchirurgie). Overhead traction was applied in 27 children with a mean age of 19.9 months (group I), and a 90–90 skeletal traction was performed in 25 children with a mean age of 47 months (group II). This treatment was followed by spica casting on an outpatient basis. At a mean follow-up of 6 11/12 years (2 4/12–12 5/12) in 33 children all fractures were healed and no malalignment with clinical relevance could be observed. In four patients the limb overgrowth was 15–20 mm. The assessment of psychological and somatic aspects revealed disturbances in the family environment. The average length of hospitalization was much shorter in group I (mean: 17.4 days) than in group II (mean: 23.7 days). Our study confirms the good long-term results after conservative treatment of femoral shaft fractures in children up to 6 years. Social and psychological problems due to the prolonged period of hospitalization as well as the high costs of skeletal traction favor surgical treatment for children older than 3–4 years.     

加长型PFNA治疗股骨干骨折伴同侧髋部骨折的临床观察

目的探讨股骨干骨折合并同侧髋部骨折的手术方法和疗效。方法分析自2006年10月至2009年6月应用手术治疗资料完整的20例股骨干骨折合并同侧髋部骨折患者,其中男16例,女4例;年龄27~57岁,平均42.6岁。股骨转子间骨折伴股骨干骨折10例,转子间骨折按Evans-Jensen分型,Ⅰ型1例,Ⅱ型3例,Ⅲ型2例,Ⅳ型4例;股骨颈骨折按G arden分型,Ⅰ型3例,Ⅱ型4例,Ⅲ型3例。17例患者伴有合并伤。结果本组随访12~24个月,平均21.5个月。所有股骨颈骨折均愈合,平均愈合时间为16周,无一例发生股骨头坏死;股骨转子间骨折平均愈合时间为16.2周;全部股骨干骨折均愈合,2例延迟愈合,平均愈合时间为22.2周。手术并发症4例。按F riedm an-W ym an评分标准评定,优14例,良4例,差2例,优良率90%。结论加长型PFNA是治疗股骨干骨折合并同侧髋部骨折可用的有效方法。     

交锁髓内钉治疗陈旧性股骨干骨折

目的：提高交锁髓内钉治疗陈旧性股骨干骨折的效果。方法：对13例陈旧性股骨干骨折采用交锁髓内钉扩髓静力型固定。结果：经6个月-2年4个月随访，骨折全部愈合，关节功能显著改善。结论：交锁髓内钉是治疗陈旧性股骨干骨折的理想方法。对内固定失败选用交锁髓内钉治疗是有效的补救措施。术后可早期功能锻炼。对膝关节功能恢复优于AO钢板固定。     

Knochen und Weichteilsarkome

There are two essential age peaks in pediatric femoral shaft fractures. The first peak concerns children between the ages of 2–4 years and the second peak is around puberty. In young children femoral shaft fractures may occur due to a relatively minor accident but the accident mechanism in older children usually involves high-velocity trauma. In children that are not yet at the walking stage, child abuse must always be excluded as the cause of the fracture. Treatment of femoral shaft fractures up to the age of 3 years is usually conservative by means of a cast or extension therapy, whereas in older children this is the domain of elastic stable intramedullary nailing (ESIN).     

Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing

Purpose

The objectives of this study were to retrospectively investigate the clinical and radiological outcome of humeral shaft fractures treated by ESIN in children <16 years old and to evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH^®).

Methods

We retrospectively evaluated children with fractures of the humeral shaft, surgically treated by ESIN. All the patients were regularly followed clinically and radiographically for at least 1 year after their index surgery. After hardware removal, the patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH).

Results

Thirty-eight patients met the inclusion criteria. Mean age at the time of trauma was 11.1 years. Mean follow-up was 30 months. All fractures healed, but three patients had a residual valgus of >10°, two a residual varum of >10°, four a residual recurvatum deformity of >10°, and one a residual procurvatum deformity of >10°. Four complications were observed. Functional outcome was nevertheless good in all the patients, with a mean Quick DASH^® score of 3.

Conclusion

The study shows good clinical and functional outcomes in children and adolescents with closed isolated fractures of the humeral shaft surgically treated by ESIN, even with ensuing mild residual frontal and sagittal plane deformity. However, conservative treatment has also been advocated in the scientific literature for this type of injuries, and surgical treatment should not be considered as the only option for the management of humeral shaft fractures in older children and adolescents.

     

Intramedullary nailing of femoral fractures in children through the lateral aspect of the greater trochanter using a modified rigid humeral intramedullary nail: preliminary results of a new technique in 15 children

OBJECTIVES: To evaluate the clinical results of intramedullary nailing of femoral shaft fractures using a rigid intramedullary nail placed through the lateral aspect of the greater trochanter in older children and adolescents. DESIGN: A retrospective study was carried out evaluating all skeletally immature patients with femoral shaft fractures treated using a modified rigid humeral intramedullary nail. PATIENTS/PARTICIPANTS: Fifteen children and adolescents with displaced femoral diaphyseal fractures and open physes. INTERVENTION: Femoral shaft fractures in children and adolescents were stabilized using a modified humeral intramedullary nail placed through the lateral aspect of the greater trochanter. MAIN OUTCOME MEASUREMENTS: Patients were evaluated to determine time to union, final fracture alignment, hospital stay, complications, clinical outcome, and proximal femoral changes including avascular necrosis or proximal femoral valgus with femoral neck narrowing. RESULTS: Fifteen patients were followed for a minimum of 1 year (range 70-157 weeks). The average age of the patients was 12 years and 5 months (range 8 years and 2 months-17 years and 1 month). All fractures healed at a mean of 7 weeks (range 5-14 weeks) after fracture. The average hospital stay for patients with isolated femur fractures (8/15) was 2.8 days (range 1-5 days). At an average follow-up of 141 weeks (range 70-326 weeks), no patient had developed avascular necrosis, femoral neck valgus, femoral neck narrowing, or other complications. CONCLUSIONS: The technique of intramedullary nailing in children through the lateral aspect of the greater trochanter seems to be safe, effective, and well tolerated by patients.     

An Observational Cohort Study of the Adoption of Elastic Stable Intramedullary Nailing for the Treatment of Pediatric Femur Fractures in Kumasi,Ghana

Background

In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5–11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with skin traction to union. This study was designed to report the early results and costs of the adoption of ESIN at KATH to provide data to other low- and middle-income sites considering adoption of this surgical technique.

Methods

An observational cohort study that included 84 pediatric patients ages 3–14 years presenting with closed femur fractures and treated with either skin traction or ESIN. Multivariate logistic regression was used to compare the rate of treatment success between treatment groups.

Results

Treatment success (coronal and sagittal angulation less than 10 ° and shortening less than 15 mm at osseous union) was achieved in 92 % of the ESIN group versus 67 % of the skin traction group (odds ratio for ESIN group 9.28 (1.6–54.7); p = 0.0138). Average length of stay was significantly lower in the ESIN group (p = 0.001), but charges to patients were higher in the ESIN group (p < 0.001) because of the high cost of implants.

Conclusions

The initial experience of operative treatment of femoral shaft fractures in children using ESIN was positive, with improved rates of treatment success and no surgical complications. Because of the high cost of implants, direct costs of treatment remained higher with ESIN despite reductions in length of hospital stay.     

Tibial shaft fractures in the adolescents: treatment outcomes and the risk factors for complications

Background: Tibial shaft fractures are common injuries in the adolescent age group. The optimal method of treatment in this age group is still controversial. It relies on several factors including patient's age, fracture pattern, fracture location, and the condition of the soft tissue envelope. The purpose of this study was to report the clinical and radiographic outcomes of adolescent tibial shaft fractures treatment at a level-I trauma center.Methods: This retrospective study reviewed consecutive patients between 10 and 18 years of age who suffered from tibial shaft fractures between 2009 and 2018 at a level-I trauma center. Outcomes of interest were the successful fracture union (primary outcome) as evaluated by the Radiographic Union Scale in Tibial fractures (RUST) and the complications (secondary outcomes).Results: Fifty-two consecutive adolescent patients treated for tibial shaft fractures using elastic stable intramedullary nails (ESIN), interlocking nails, plates and screws, external fixators, and casts were included in the study. The mean follow-up period was 27.4 months. There was no statistically significant difference in the union rate and time to fracture union between the different treatment methods. Subject weight, fracture type, and method of treatment were significant predictors for the RUST scores at 12 weeks post-operative. Adolescents with heavier bodyweight correlated with lower RUST scores (p<0.001). Open fractures were associated with significantly longer time to union (p<0.001) and lower RUST scores (p<0.001) compared to closed fractures. The patients treated with interlocking nailing showed higher RUST scores than the casting treatment group (p = 0.01). There were no statistically significant differences in complication rates between the fixation methods. Union time was significantly longer with complications than without complications (p = 0.01). Open fractures had higher complication rates compared to closed fractures. In the multivariate logistic model, patients with open fracture were 5.5 times more likely to have complications (OR=5.46; p = 0.04).Conclusion: Tibial shaft fractures in adolescents can be treated with several methods including ESIN, interlocking nail, plate and screws, external fixation, and casting. All are valid treatments for adolescent tibial shaft fractures and can achieve favorable outcomes. No single treatment method applies to all patients. Each method has advantages, disadvantages, and specific indications.