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

•Tibial shaft fractures are common injuries in the adolescent age group.•The available treatment options include elastic stable intramedullary nails, interlocking nails, plates and screws, external fixators, and casting. The ideal treatment method of these fractures in the adolescent age group is still controversial.•In the present study, all the treatment methods achieved favorable outcomes with comparable union rates, time to fracture union, and complication rates. The patient group treated with interlocking nailing had higher RUST scores than the casting group.•Heavyweight adolescent patients correlated with lower RUST scores. Open fractures were associated with significantly longer time to union, lower RUST scores, and higher complication rates.•No single treatment method applies to all patients, each method has advantages, disadvantages, and specific indications. Each patient should be evaluated independently to determine the best fixation method. 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