Introduction Among the most frequently encountered pediatric fractures. Consists of traumatic tibial shaft +/- fibula fractures most commonly due to pedestrian vs vehicle (50%) Toddler's fracture (see below) Epidemiology 15% of all pediatric fractures 39% of tibia fractures occur in the diaphysis. 30% are associated with a fibula fracture. usually undisplaced because of strong periosteum Prognosis healing 3 to 4 weeks for toddler's fracture 6 to 8 weeks for other tibial fractures Toddler's fracture characteristics nondisplaced spiral or oblique fracture of tibial shaft only fibula remains intact also known as childhood accidental spiral tibial (CAST) fractures age group children< 3 years (walking toddlers) unlike child abuse injury, which occurs in children not yet walking mechanism low energy trauma with rotational component involves distal half of tibia unlike non-accidental injury, which typically involves proximal half of tibia Presentation Symptoms pain bruising limping or refusal to bear weight Physical exam warmth, swelling over fracture site tender over fracture site pain on ankle dorsiflexion always have high suspicion for compartment syndrome Imaging Radiographs views AP and lateral views of the tibia and fibula are required ipsilateral knee and ankle must be evaluated to rule out concomitant injury findings Toddler's fracture are nondisplaced spiral tibial shaft fracture Treatment Traumatic Tibia +/- Fibular fx Nonoperative closed reduction and long leg casting indications almost all Toddler's fracture most traumatic fractures displaced with acceptable reduction 50% apposition < 1 cm of shortening < 5-10 degrees of angulation in the sagittal and coronal planes followup follow up xrays in 2 weeks to evaluate for callus in order to confirm diagnosis in equivocal cases serial radiographs are performed to monitor for developing deformity prolonged immobilization (3 months) compared to flexible IMN Operative surgical treatment indications (< 5% of tibia shaft fractures) unacceptable reduction (see above) marked soft tissue injury open fractures unstable fractures compartment syndrome neurovascular injury multiple long bone fractures >1cm shortening unacceptable alignment following closed reduction (>10deg angulation) techniques include external fixation plate fixation percutaneous pinning flexible IM nails Techniques Long Leg Casting immobilization is performed with a long leg cast with the knee flexed to provide rotational control and prevent weight bearing. External fixation open fractures with extensive soft tissue injury is most common indication most common complication is malunion nonunion (~2%) Plate fixation Percutaneous pinning younger patients Flexible or rigid intramedullary rods depending on the age of the patient and degree of soft tissue injury complications nonunion (~10%) malunion infection Complications Compartment syndrome with both open and closed fractures Leg-length discrepancy Angular deformity varus for tibia only fractures valgus for tibia-fibula fractures Associated physeal injury proximal or distal Delayed union and nonunion usually only after external fixation
QUESTIONS 1 of 2 1 2 Previous Next (OBQ09.141) A 2-year and 11-month old child fell while playing with friends 2 hours ago and has avoided bearing weight on the right leg since that time. The child is afebrile and exam reveals tenderness along the distal tibial shaft with no significant swelling. Radiographs are shown in Figure A and B. What is the most appropriate treatment? Review Topic QID: 2954 FIGURES: A B 1 MRI of the tibia 0% (12/3293) 2 Aspiration of the tibia 0% (4/3293) 3 Referral to child services 3% (105/3293) 4 Long leg cast application 95% (3140/3293) 5 Serum vitamin D, calcium, and phosphate levels 1% (22/3293) Select Answer to see Preferred Response PREFERRED RESPONSE 4 (OBQ07.60) A 23-month-old girl refuses to bear weight since falling on the playground yesterday. The child is afebrile and her WBC and erythrocyte sedimentation rate (ESR) are within normal limits. On physical exam the leg has no erythema, but does have mild tenderness along the distal tibial shaft. Plain radiographs are negative. What is the most appropriate management? Review Topic QID: 721 1 vitamin D and calcium levels 5% (49/934) 2 MRI of the pelvis 4% (39/934) 3 long leg cast 88% (824/934) 4 chromosomal analysis 1% (7/934) 5 aspiration of the knee 1% (12/934) Select Answer to see Preferred Response PREFERRED RESPONSE 3
Adolescent TIb-fib Fracture (C2482) Pediatrics - Tibia Shaft Fracture - Pediatric HPI - 13 year-old male experienced trauma two weeks ago and suffered both bone fracture. The patient was initially treated in a long let cast. Based on the 2 week xrays, how would you treat this pediatric tib-fib fracture? 1/16/2016 466 2 3 Distal tibia and fibula fracture (C2208) Pediatrics - Tibia Shaft Fracture - Pediatric HPI - struck by car no soft tissues problem, no other injuries, neurovascularly intact. What is the best treatment option? 4/25/2015 191 1 9 Peds tibia shaft fx (C1194) Pediatrics - Tibia Shaft Fracture - Pediatric HPI - 12 year old female softball player got her cleats stuck sliding into home plate and twisted her lower leg. Treatment for this adolescent tibial shaft fracture 4/24/2012 1046 1 29