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Tibial Shaft Fractures in Children and Adolescents

Dr. Mashru is Trauma Fellow, Campbell Clinic, University of Tennessee College of Medicine, Memphis, TN. Dr. Herman is Assistant Professor, Orthopedics and Pediatrics, Orthopedic Center for Children, St. Christopher’s Hospital for Children, Philadelphia, PA. Dr. Pizzutillo is Chief, Orthopedic Surgery Section, Director, Orthopedic Center for Children, and Professor, Pediatrics and Orthopedic Surgery, St. Christopher’s Hospital for Children, Philadelphia.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Mashru, Dr. Herman, and Dr. Pizzutillo.

Reprint requests: Dr. Herman, Orthopedic Center for Children, St. Christopher’s Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134.

Tibial shaft fractures are among the most common pediatric injuries managed by orthopaedic surgeons. Treatment is individualized based on patient age, concomitant injuries, fracture pattern, associated soft-tissue and neurovascular injury, and surgeon experience. Closed reduction and casting is the mainstay of treatment for diaphyseal tibial fractures. Careful clinical and radiographic follow-up with remanipulation as necessary is effective for most patients. Surgical management options include external fixation, locked intramedullary nail fixation in the older adolescent with closed physis, Kirschner wire fixation, and flexible intramedullary nailing. Union of pediatric diaphyseal tibial fractures occurs in approximately 10 weeks; nonunion occurs in <2% of cases. Some clinicians consider sagittal deformity angulation >10° to be malunion and indicate that 10° of valgus and 5° of varus may not reliably remodel. Compartment syndromes associated with tibial shaft fractures occur less frequently in children and adolescents than in adults. Diagnosis may be difficult in a young child or one with altered mental status. Although the toddler fracture of the tibia is one of the most common in children younger than age 2 years, child abuse must be considered in the young child with an inconsistent history or with suspicious concomitant injuries.

This article has been cited by other articles:

				N. Gougoulias, A. Khanna, and N. Maffulli Open tibial fractures in the paediatric population: a systematic review of the literature Br. Med. Bull., September 1, 2009; 91(1): 75 - 85. [Abstract] [Full Text] [PDF]

				Correspondence. J. Am. Acad. Ortho. Surg., March 1, 2006; 14(3): 191 - 191. [Full Text] [PDF]