Pediatric Tibial Fracture
- Shortening:
- pediatric tibial frxs do not have much potential for overgrowth, hence, it is essential to to maintain frx out to length;
- when shaft of tibia & fibula are fractured, major problem, is shortening;
- w/ fibula no longer intact, long flexor muscles tend to produce a valgus deformtiy at the fracture site;
- acceptable shortening:
- 1 to 5 yrs of age: 5 - 10 mm
- 5 to 10 yrs of age: 0 - 5 mm
- pediatric tibial frxs do not have much potential for overgrowth, hence, it is essential to to maintain frx out to length;
- when shaft of tibia & fibula are fractured, major problem, is shortening;
- w/ fibula no longer intact, long flexor muscles tend to produce a valgus deformtiy at the fracture site;
- acceptable shortening:
- 1 to 5 yrs of age: 5 - 10 mm
- 5 to 10 yrs of age: 0 - 5 mm
- Axial Malalignment:
- frxs of tibia and fibula do not have much poential to correct axial malalignment;
- acceptable reduction:
- less than 10 deg of recurvatum;
- less than 5 deg of varus or valgus angulation;
- frxs of tibia and fibula do not have much poential to correct axial malalignment;
- acceptable reduction:
- less than 10 deg of recurvatum;
- less than 5 deg of varus or valgus angulation;
- Treatment:
- cast application:
- frx of tibial & fibular shafts in children are usually uncomplicated and can be treated by closed reduction and long leg cast application;
- flexion to 45 deg will facilitate rotational control of the fracture;
- w/ a recurvatum deformity, the foot should be placed in slight plantar-flexion: neutral dorsiflexion will increase frx recurvatum in an unstable frx;
- in older children, the long leg cast can be converted to a patellar tendon bearing cast after a period of 3 weeks;
- intramedullary nails: (synthes technique manual)
- references:
- Intramedullary Kirschner wiring for tibia fractures in children.
- Operative Treatment of Tibial Fractures in Children: Are Elastic Stable Intramedullary Nails an Improvement Over External Fixation?
- Intramedullary Flexible Nail Fixation of Unstable Pediatric Tibial Diaphyseal Fractures.
- external fixation:
- External fixation of lower limb fractures in children.
- cast application:
- frx of tibial & fibular shafts in children are usually uncomplicated and can be treated by closed reduction and long leg cast application;
- flexion to 45 deg will facilitate rotational control of the fracture;
- w/ a recurvatum deformity, the foot should be placed in slight plantar-flexion: neutral dorsiflexion will increase frx recurvatum in an unstable frx;
- in older children, the long leg cast can be converted to a patellar tendon bearing cast after a period of 3 weeks;
- intramedullary nails: (synthes technique manual)
- references:
- Intramedullary Kirschner wiring for tibia fractures in children.
- Operative Treatment of Tibial Fractures in Children: Are Elastic Stable Intramedullary Nails an Improvement Over External Fixation?
- Intramedullary Flexible Nail Fixation of Unstable Pediatric Tibial Diaphyseal Fractures.
- external fixation:
- External fixation of lower limb fractures in children.
- Varus Mal-Reduction:
- oblique isolated frx of tibial shaft (w/ fibula intact) may drift into varus because of pull of long flexors of the toes & ankle;
- varus mal-reduction is addressed by placing knee in flexion & ankle in mild plantar flexion during first 1-2 weeks of immobilization;
- oblique isolated frx of tibial shaft (w/ fibula intact) may drift into varus because of pull of long flexors of the toes & ankle;
- varus mal-reduction is addressed by placing knee in flexion & ankle in mild plantar flexion during first 1-2 weeks of immobilization;
Original Text by Clifford R. Wheeless, III, MD.
Labels: Orthopaedics
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