Table 2.
Summary of key studies
| Study | Design | Size | Patient demographics | Technique | Reason for flexible nailing | Outcome measures | Results | |
|---|---|---|---|---|---|---|---|---|
| Mean age (range) | M:F ratio | |||||||
| Goodwin et al. [6] | Retrospective case series | 19 | 12 years (9–15) | 16:3 | Ti Elastic (17) or Ender (2) × 2 (×4 if tibia large) | Unstable # (11), open # (8) | Radiographic union, complications | 3 delayed unions, 2 malunions, 1 premature physeal closure |
| Gordon et al. [7] | Retrospective case series | 60 | 11.9 years (5–17) | 35:15 | Flexible Ti × 2 (1 pt × 1) | Unstable (34), open (26) | Radiographic union, alignment, leg length, complications | 45 unions 8 weeks (4–18), 5 delayed unions (31–51 weeks), 1 malunion, 7 LLD, 1 infection |
| Kubiak et al. [8] | Retrospective case series | 16 | 11 years (7–14) | 11:5 | Elastic × 2 | Surgeon choice | Union, alignment, complications | Union 7 weeks (5–12), 1 bony overgrowth secondary to nail, no malunion, no infections |
| O’Brien et al. [9] | Retrospective case series | 16 | 10 years 4 months | 12:2 | Flexible Ti × 2 | Failed closed reduction (11), open # (3), multiple injuries (2) | Radiographic union, infection, knee pain, knee/ankle range of motion | Union 9 weeks, no infection or knee pain, K&A ROM normal |
| Sankar et al. [10] | Retrospective case series | 19 | 12.2 years (7.2–16) | 14:5 | Ti Elastic × 2 | Unstable (12), open # (5), impending compartment syndrome (2) | Radiographic union, leg length, malalignment, pain, complications | Union 11 weeks (6–18), 4 malunions, no LLD, no infections, 2 repeat MUA |
| Srivastava et al. [11] | Retrospective case series | 24 | 11 years (4 years 6 months–16 years 4 months) | 21:3 | Nancy nails | Open (16), unstable (8) | Radiographic union, leg length, complications | Union 20.7 weeks, 2 non-unions, 2 infections, 2 malunions, 2 LLD |
| Vallamshetla et al. [12] | Retrospective case series | 56 | 12 years (4–16) | 43:11 | Flexible Ti × 2 | Polytrauma (23), failed closed reduction (20), open (13) | Clinical & radiographic union, leg length, complications | Union 10 weeks (7–18), 3 infections (all open), 2 malunions, 2 LLD |
LLD limb length discrepancy; ROM range of motion, MUA manipulation under anaesthetic