Abstract
Tibial shaft fractures are one of the most common pediatric fractures. They require appropriate diagnosis and treatment to minimize complications and optimize outcomes. Diagnosis is clinical and radiological, which can be difficult in a young child or with minimal clinical findings. In addition to acute fracture, Toddler’s and stress fractures are important entities. Child abuse must always be considered in a nonambulatory child presenting with an inconsistent history or suspicious concomitant injuries. Treatment is predominantly nonoperative with closed reduction and casting, requiring close clinical and radiological followup until union. Although there is potential for remodeling, this may not be adequate with more significant deformities, thus requiring remanipulation or rarely, operative intervention. This includes flexible intramedullary nailing, Kirschner wire fixation, external fixation, locked intramedullary nailing, and plating. Complications are uncommon but include deformity, growth arrest, nonunion, and compartment syndrome.
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Shannak AO. Tibial fractures in children: Followup study. J Pediatr Orthop 1988;8:306–10.
Egol KA, Koval KJ, Zuckerman JD. Handbook of Fractures. 5th ed. Philadelphia, USA: Lippincott, Williams and Wilkins; 2015.
Yang JP, Letts RM. Isolated fractures of the tibia with intact fibula in children: A review of 95 patients. J Pediatr Orthop 1997;17:347–51.
Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 2005;13:345–52.
King J, Diefendorf D, Apthorp J, Negrete VF, Carlson M. Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 1988;8:585–9.
Houdek MT, Wagner ER, Wyles CC, Sems SA, Moran SL. Reverse medial hemisoleus flaps for coverage of distal third leg wounds: A technical trick. J Orthop Trauma 2016;30:e138–42.
Moulton SL. Early management of the child with multiple injuries. Clin Orthop Relat Res 2000;376:6–14.
Pandya NK, Upasani VV, Kulkarni VA. The pediatric polytrauma patient: Current concepts. J Am Acad Orthop Surg 2013;21:170–9.
Canavese F, Botnari A, Andreacchio A, Marengo L, Samba A, Dimeglio A, et al. Displaced tibial shaft fractures with intact fibula in children: Nonoperative management versus operative treatment with elastic stable intramedullary nailing. J Pediatr Orthop 2016;36:667–72.
Setter KJ, Palomino KE. Pediatric tibia fractures: Current concepts. Curr Opin Pediatr 2006;18:30–5.
Ho CA. Tibia shaft fractures in adolescents: How and when can they be managed successfully with cast treatment? J Pediatr Orthop 2016;36 Suppl 1:S15–8.
Kinney MC, Nagle D, Bastrom T, Linn MS, Schwartz AK, Pennock AT. Operative versus conservative management of displaced tibial shaft fracture in adolescents. J Pediatr Orthop 2016;36:661–6.
Norman D, Peskin B, Ehrenraich A, Rosenberg N, Bar-Joseph G, Bialik V. The use of external fixators in the immobilization of pediatric fractures. Arch Orthop Trauma Surg 2002;122:379–82.
Gougoulias N, Khanna A, Maffulli N. Open tibial fractures in the paediatric population: A systematic review of the literature. Br Med Bull 2009;91:75–85.
Herman MJ, Martinek MA, Abzug JM. Complications of tibial eminence and diaphyseal fractures in children: Prevention and treatment. J Am Acad Orthop Surg 2014;22:730–41.
Griffet J, Leroux J, Boudjouraf N, Abou-Daher A, El Hayek T. Elastic stable intramedullary nailing of tibial shaft fractures in children. J Child Orthop 2011;5:297–304.
Vallamshetla VR, De Silva U, Bache CE, Gibbons PJ. Flexible intramedullary nails for unstable fractures of the tibia in children. An eight-year experience. J Bone Joint Surg Br 2006;88:536–40.
Marengo L, Paonessa M, Andreacchio A, Dimeglio A, Potenza A, Canavese F, et al. Displaced tibia shaft fractures in children treated by elastic stable intramedullary nailing: Results and complications in children weighing 50 kg (110 1b) or more. Eur J Orthop Surg Traumatol 2016;26:311–7.
Economedes DM, Abzug JM, Paryavi E, Herman MJ. Outcomes using titanium elastic nails for open and closed pediatric tibia fractures. Orthopedics 2014;37:e619–24.
Sahu RL, Ranjan R. Fracture union in percutaneous kirschner wire fixation in paediatric tibial shaft fractures. Chin J Traumatol 2016;19:353–7.
Yusof NM, Oh CW, Oh JK, Kim JW, Min WK, Park IH, et al. Percutaneous plating in paediatric tibial fractures. Injury 2009;40:1286–91.
Hope PG, Cole WG. Open fractures of the tibia in children. J Bone Joint Surg Br 1992;74:546–53.
Liow RY, Montgomery RJ. Treatment of established and anticipated nonunion of the tibia in childhood. J Pediatr Orthop 2002;22:754–60.
Livingston KS, Glotzbecker MP, Shore BJ. Pediatric acute compartment syndrome. J Am Acad Orthop Surg 2017;25:358–64.
Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: Contemporary diagnosis, treatment, and outcome. J Pediatr Orthop 2001;21:680–8.
Tenenbein M, Reed MH, Black GB. The toddler’s fracture revisited. Am J Emerg Med 1990;8:208–11.
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Patel, N.K., Horstman, J., Kuester, V. et al. Pediatric Tibial Shaft Fractures. IJOO 52, 522–528 (2018). https://doi.org/10.4103/ortho.IJOrtho_486_17
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DOI: https://doi.org/10.4103/ortho.IJOrtho_486_17