Tibial Fractures Pediatric

Contributes 57% of tibial length. Located 1-2 cm distal to joint line. Protected by tibial tubercle apophysis.

Contributes 43% of tibial length. Asymmetric closure (central, then medial, then lateral).

Secondary ossification center. Vulnerable during adolescence (Osgood-Schlatter).

Enters posterior cortex at junction of proximal and middle thirds. Supplies inner 2/3 of cortex.

Supply outer 1/3 of cortex. More robust in children = better healing.

Vulnerable area at popliteal trifurcation. Watch for vascular injury with displaced proximal fractures.

Subcutaneous, minimal soft tissue coverage. Risk of open fractures and wound complications.

Four leg compartments. Children can develop compartment syndrome. Floating knee has highest risk.

Thick in children. Helps maintain reduction. Contributes to rapid healing.

Spiral, oblique, transverse, comminuted

Proximal, middle, distal third

Stable (isolated tibia, intact fibula) vs unstable (both bones, significant displacement)

Intact fibula may cause valgus malunion. Both bone fractures are unstable.

AP and lateral tibia/fibula. Include knee and ankle joints.

May be negative initially. Look for subtle periosteal reaction at 10-14 days. Bone scan or MRI if clinical suspicion high.

AP and lateral knee. CT if surgical planning needed.

Occult toddler's fracture, tibial spine assessment, associated soft tissue injury.

Tibial spine fracture surgical planning, complex intra-articular fractures.

Rarely needed. Can confirm occult toddler's fracture if clinical suspicion.

Long leg cast or walking boot for 3-4 weeks.

• Treat clinically even if X-ray negative
• No reduction needed (non-displaced)
• Rapid healing in this age group
• Follow-up X-ray at 2 weeks shows callus

Excellent. Heals rapidly with no long-term sequelae.

Long leg cast for 4-6 weeks. Anatomic reduction attempted but not essential.

Progressive valgus develops 6-18 months post-injury.

Spontaneous correction by skeletal maturity in most cases.

Overcorrecting into varus acutely. Performing early osteotomy for valgus. Promising parents deformity will not occur.

Extension cast for 4-6 weeks. Non-weight bearing initially.

Attempt closed reduction with extension. If reducible, cast. If blocked by intermeniscal ligament, surgery.

Surgical fixation (open or arthroscopic). Options include suture fixation, screw fixation.

ROM after healing. ACL rehab protocol.

More unstable. Lower threshold for operative fixation.

Age over 6-10 years, unstable shaft fractures, polytrauma.

Medial and lateral distal metaphysis (avoid physis).

40% of medullary canal at isthmus.

Pre-contour nails for apex anterior angulation. Avoid proximal entry (tibial tubercle physis damage).

Arthroscopic preferred, open if needed.

• Suture fixation through bone tunnels
• Screw fixation (avoid physes)
• Suture anchors

Clear intermeniscal ligament if blocking reduction.

Extension brace or cast 4-6 weeks.

Ipsilateral femur and tibia fractures.

High energy trauma (MVA, fall from height).

Knee ligament injuries (40-80%), vascular injuries, other trauma.

Usually requires surgical stabilization of both levels. Femur typically flexible nails. Tibia cast or nails depending on pattern.

Highest risk of compartment syndrome. LLD possible.

Simple bone cyst, fibrous dysplasia, osteogenesis imperfecta.

Fracture with minimal trauma. May have prior symptoms.

Treat fracture first. Address underlying pathology. Curettage and bone graft for cysts if needed.