Paediatric Tibial Shaft Fractures

Proximal Tibial Epiphysis

  • Infrequent injuries
  • Usually by direct force
  • Usually SH II
  • Very high incidence of vascular injury to popliteal vessel

Treatment

  • Undisplaced – cast treatment
  • Displaced – closed reduction & if unstable crosssed pins
  • If intraarticular need exact reduction
  • Monitor post-reduction for neurovascular status

Pro>Proximal Tibial Metaphysis

  • Usually incomplete fracture with valgus
  • Mold in varus & full extension
  • May get valgus deformity – in general wait up to 3 years for correction

Tibia>Tibial Diaphysis

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  • Most uncomplicated tibial fractures are managed in a cast
  • Growth acceleration  of 5-7 mm
  • Acceptable Reduction
    • Valgus & varus of 5°
    • Recurvatum of 10°

    • Operati>Operative Indications

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  • Open fracture
  • Compartment syndrome
  • Polytrauma
  • Soft tissue injury
  • Failed closed management

    • Techniq>Techniques of Fixation

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  • External Fixation
    • 4 mm half pins in kids
    • 5-6 mm half pins in adolescents
  • IM
    • generally not amenable until skeletal maturity
  • Compression Plates
    • rarely required