Pediatric tibial shaft fracture with ipsilateral intraarticular distal tibial fracture: A cross sectional study of impact on management and outcomes

Abstract

Background: Tibial fractures are common in a pediatric population. However, this study describes a more complicated fracture pattern that has been infrequently defined in the pediatric orthopaedic literature: tibial shaft fractures with an ipsilateral intraarticular distal tibial fracture. Methods: One hundred and ninety patients at a large pediatric tertiary care hospital from 2006-2016 were included in this retrospective chart review, as identified by eligible Current Procedural Terminology (CPT) codes. Variables assessed included patient demographics, injury characteristics, follow-up time, weight bearing, and immobilization. Complications and secondary treatments were recorded when present. Results: Of 190 patients included in the study, 16 were identified with an ipsilateral tibial shaft and ankle fracture pattern. The mean age of patients with the combined fracture pattern was 15.3 yr, compared to 12.3 yr for patients who only had a tibial shaft fracture. Additionally, immobilization was employed in patients with combined fractures for 12.3 wk, significantly longer than with isolated shaft fracture (9.0 wk). The mechanism of injury for the combined shaft and ankle fractures was more likely to be described as “twisting,” compared to the isolated shaft fractures. Despite the risk of complications with fracture communication into the articular surface, patients with shaft and ankle fractures had excellent outcomes. Conclusions: We describe tibial shaft fractures with an ipsilateral intraarticular distal tibial fracture, an injury pattern that has not been well characterized in the literature. Patient characteristics (age, mechanism of injury) may contribute to development of this injury, and these patients may require different management than those with isolated tibial shaft fractures. Level of Evidence: Level IV.