Treatment of Unstable Pediatric Tibia Shaft Fractures in FinlandFunding None.
02 November 2017
16 January 2018
28 February 2018 (eFirst)
Background Surgical treatment of pediatric tibia shaft fractures has gained popularity despite closed reduction and cast-immobilization providing good long-term results. There is no consensus about optimal methods and satisfactory quality of treatment.
Materials and Methods During 2010 to 2014, 226 pediatric patients were treated under anesthesia for tibia shaft fractures in Finland's five university hospitals. A total of 164 (73%) patients had closed fractures of the tibia or both tibia and fibula without other injuries (62 tibia only and 102 both tibia and fibula). Forty-one (18%) had open tibia fractures, 16 had additional fractures, and 5 (2%) had sustained a polytrauma (Injury Severity Score [ISS] > 15). Treatment methods, follow-up protocols, complications, and the outcome were analyzed.
Results A total of 143 (63%) of the tibia fractures were treated surgically: 87 (53%) closed fractures, 36 (88%) open fractures, 15 (94%) with additional fractures, and 5 (2%) polytrauma patients. The rate of surgical treatment of closed tibia fractures was significantly higher in patients older than 10 and in patients with a concomitant fibula fracture. Fasciotomy was done in 33 (15%) patients. Reoperations were performed in 13 (6%) patients because of unsatisfactory treatment (inappropriate primary reduction 6, malunion 6, and non-union 1). There were no differences between the five university hospitals in treatment or follow-up protocols.
Conclusion Internal fixation is used for the majority of tibia shaft fractures treated under anesthesia in university hospitals in Finland. Serious fracture or treatment related complications are very rare, but the percentage (6%) of re-operations because of unsatisfactory standard of treatment should be lower and could probably be improved by concentrating internal fixation to fewer hands. A prospective randomized controlled trial comparing non-operative treatment to intramedullary nailing in pediatric tibia fractures should be performed.
- 1 Setter KJ, Palomino KE. Pediatric tibia fractures: current concepts. Curr Opin Pediatr 2006; 18 (01) 30-35
- 2 Galano GJ, Vitale MA, Kessler MW, Hyman JE, Vitale MG. The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 2005; 25 (01) 39-44
- 3 Shannak AO. Tibial fractures in children: follow-up study. J Pediatr Orthop 1988; 8 (03) 306-310
- 4 Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 2005; 13 (05) 345-352
- 5 Yang J-P, Letts RM. Isolated fractures of the tibia with intact fibula in children: a review of 95 patients. J Pediatr Orthop 1997; 17 (03) 347-351
- 6 Lowe J, Bab I, Stein H, Sela J. Primary calcification in remodeling haversian systems following tibial fracture in rats. Clin Orthop Relat Res 1983; xx (176) 291-297
- 7 Heinrich SD, Mooney JF, Beaty JH, Kasser JR. Fractures of the shaft of the tibia and fibula. Rockwood Wilkin's Fractures 2006; 25: 937-942
- 8 Palmu S, Paukku R, Mäyränpää MK, Peltonen J, Nietosvaara Y. Injuries as a result of treatment of tibial fractures in children: claims for compensation submitted to the Patient Insurance Center in Finland. Acta Orthop 2009; 80 (01) 78-82
- 9 Palmu SA, Auro S, Lohman M, Paukku RT, Peltonen JI, Nietosvaara Y. Tibial fractures in children. A retrospective 27-year follow-up study. Acta Orthop 2014; 85 (05) 513-517
- 10 Schmittenbecher PP, Dietz HG, Linhart WE, Slongo T. Complications and problems in intramedullary nailing of children's fractures. Eur J Trauma 2000; 26: 287-293
- 11 Gordon JE, O'Donnell JC. Tibia fractures: what should be fixed?. J Pediatr Orthop 2012; 32 (Suppl. 01) S52-S61
- 12 Gicquel P, Giacomelli M-C, Basic B, Karger C, Clavert J-M. Problems of operative and non-operative treatment and healing in tibial fractures. Injury 2005; 36 (Suppl. 01) A44-A50
- 13 Canavese F, Botnari A, Andreacchio 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 (07) 667-672
- 14 Gordon JE, Gregush RV, Schoenecker PL, Dobbs MB, Luhmann SJ. Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop 2007; 27 (04) 442-446
- 15 Heo J, Oh C-W, Park K-H. , et al. Elastic nailing of tibia shaft fractures in young children up to 10 years of age. Injury 2016; 47 (04) 832-836
- 16 Goodwin RC, Gaynor T, Mahar A, Oka R, Lalonde FD. Intramedullary flexible nail fixation of unstable pediatric tibial diaphyseal fractures. J Pediatr Orthop 2005; 25 (05) 570-576