Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

Woo Young Choi,Ki Hyuk Sung,Kyoung Min Lee,Hyon Soo Jung,Kug Jin Choi,Moon Seok Park

doi:10.1186/s10195-021-00575-x

Woo Young Choi, Ki Hyuk Sung + Show 4 more

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https://doi.org/10.1186/s10195-021-00575-x

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Abstract

BackgroundThis study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures.Materials and methodsThis study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD < 1 cm and ≥ 1 cm and overgrowth < 1 cm and ≥ 1 cm.ResultsCasting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLDs < 1 cm and ≥ 1 cm. There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with overgrowth < 1 cm and ≥ 1 cm. Sex and treatment methods were risk factors associated with LLD ≥ 1 cm and overgrowth ≥ 1 cm following pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm and 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm and 4.8-fold higher risk of overgrowth ≥ 1 cm than those treated by casting.ConclusionsPatients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys.Level of evidenceLevel III

Highlights

Surgeons should consider the possibility of leg length discrepancy (LLD) and overgrowth after pediatric tibial shaft fractures, especially when performing titanium elastic nailing (TEN) for boys
Tibial shaft fractures account for about 1.1% of all pediatric fractures and are the second most common long bone fracture in a child, after forearm fractures [1, 2]
A total of 103 patients with a tibial shaft fracture were included in the analysis

Summary

Introduction

Tibial shaft fractures account for about 1.1% of all pediatric fractures and are the second most common long bone fracture in a child, after forearm fractures [1, 2]. Most of the overgrowth has been shown to occur within 18 months after the fracture, and the average overgrowth at the time of follow-up was approximately 6 mm in cases of tibial shaft fractures [17]. This is thought to be due to the physiological processes associated with posttraumatic activation of the growth plate [18, 19]. This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures

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