Tibial shaft fractures in adolescents

Ho, Christine A.; Dammann, Greg; Podeszwa, David A.; Levy, Jeffrey S.

doi:10.1097/bpb.0000000000000144

Cited by 18 publications

(13 citation statements)

References 9 publications

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“…Patients treated with instable fractures of both, tibia and fibula were mainly treated with ECMES ( Figure 2D) and may require additional stability till consolidation provided by cast. Which is in accordance with literature showing that immobilization in a cast for longer than 3 months was required in nearly 60% of patients with a combined fracture of tibia and fibula (23). The advantage of ECMES is the insertion at a position distinct from traumatic wounds, and the minimal additional damage to surrounding tissue, which is particularly important in the context of high-energy trauma settings.…”

Section: Discussionsupporting

confidence: 89%

Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

et al. 2021

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Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg.Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy.Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.

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Section: Discussionsupporting

confidence: 89%

Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

et al. 2021

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“…Treatment failure with conversion to open reduction occurred in 2/74 (2.7%) individuals who underwent casting without manipulation and 6/36 (16.7%) treated with CRC. In this series, treatment failure of casting was associated with greater initial fracture displacement and severity, consistent with prior studies of midshaft tibia fractures in adolescents [15,17].…”

Section: Discussionsupporting

confidence: 89%

“…Ho et al . [17] reported that 16/75 adolescents with midshaft tibial fractures treated with casting required a cast change or cast wedging. Three individuals were ultimately converted to operative treatment, supporting casting as an effective treatment for tibial shaft fractures in adolescents.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of displaced adolescent distal third tibia fractures: can we do better?

Ramalingam

Carry

Brazell

et al. 2021

Journal of Pediatric Orthopaedics B

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Because adolescent distal third tibia fractures pose treatment challenges, we aimed to identify factors predictive of failure among common treatment methods: casting without manipulation, closed reduction and casting (CRC) and open treatment. Among displaced fractures, we compared outcomes between CRC versus open treatment. Skeletally immature individuals (10-17 years) with extraarticular distal third tibia fractures at a level 1 trauma center (2011-2017) were retrospectively reviewed. Patient demographics, injury and treatment characteristics and complications were recorded. Radiographs were evaluated for unacceptable alignment (angulation >5°, translation >50%, and shortening >1 cm) and time to union. Of 140 individuals, casting was the most common treatment method (n = 81), followed by CRC under anesthesia/ sedation (n = 38), and open treatment (n = 34). For fractures casted without manipulation, increased fracture severity based upon our novel grading system [hazard ratio (HR): 10.5, 95% CI, 4.2-27.5, P < 0.0001] was significantly related to treatment failure. Outcomes for a selected group of 47 initially displaced fractures (33 CRC and 14 open treatments) were evaluated. For CRC, 9 (27.3%) healed with malunion and 6 (18.2%) failed initial CRC, resulting in a treatment failure rate of 36.7%. For open treatment, 2 (14.3%) underwent hardware removal, 2 (14.3%) healed with malunion and one developed infection requiring reoperation. No fractures healed with malunion required surgical correction during the study period. The odds of persistent malalignment in CRC was 3.77 [95% CI, 0.44-32.60, P = 0.2274] times open treatment. Adolescent minimally displaced distal tibial fractures can undergo successful treatment with casting. However, displaced fractures have a higher chance of short-term failure with CRC. Close monitoring of displaced fractures in the adolescent is essential during conservative management.

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“…However, the incidence of surgical interventions increased significantly with the increase in the age of the patient cohort. Ho et al reported in a retrospective study that 4% (n=3) of the adolescent patients out of 75 ultimately needed surgical fixation of tibial fractures due to changed position following long leg cast management [ 23 ]. The proportion of patients requiring surgery after a period of casting in our series is similar.…”

Section: Discussionmentioning

confidence: 99%

Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital

Chakraborty¹,

Salama²,

Lee³

2023

Cureus

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IntroductionTibia fractures are children's most typical lower limb fractures affecting their general and mental well-being. This study aims to evaluate the management and outcomes of displaced tibia fractures. MethodsA retrospective study was conducted to review children up to 16 years of age with displaced tibia shaft fractures who received treatment in our department from January 2011 to December 2021. Fractures managed in the operating theatre and patients who completed follow-up until fracture healing were included in the study. Treatment procedures were assessed, and outcome was measured by hospital stays, complications and revision procedure incidences. ResultsThe study included 74 patients (75 fractures, including one re-fracture). The patient's ages ranged from 2 to 16 years (median age: 11 years). Seven patients sustained open fractures (Gustilo I, II). Tibia diaphysis was the most common site of involvement. A total of 43 patients were treated by manipulation under anaesthesia and cast. Surgical fixation was directly proportional to increasing age (p<0.05). Overall, 74% of patients were treated by fixation when age was >10 years. Three patients needed conversion of casting to surgical fixation. One patient had re-fracture following a secondary injury after six months of initial tibia shaft fracture treated by casting. Five patients had complications, including delayed union, pin site and surgical site infections. Antibiotics were adequate to manage infections except in one patient who needed debridement. The average hospital stay was three days. The median number of follow-up X-rays was 4. The planned removal of all flexible nails, and the circular frame was done between 2 and 15 months, except for one that had delayed union. All the patients underwent clinical and radiological union at the end of the follow-up. ConclusionThe treatment plan was dependent on the individual need of the patient and the fracture pattern. Children older than 10 years were more likely to undergo surgical fixation. The majority of fractures were treated by manipulation and cast in operating theatres. Better logistic support in the emergency department could reduce the burden on the operating theatre.

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Tibial shaft fractures in adolescents

Cited by 18 publications

References 9 publications

Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

Outcomes of displaced adolescent distal third tibia fractures: can we do better?

Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital

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