Residual Deformity and Outcome in Non-Surgically Treated Tibial Shaft Fractures in Adolescents

Abstract

Background: The limited potential for correction of malalignments due to the impending physeal closure predisposes adolescents to inadequate alignment of tibial shaft fractures, hence the need for close to anatomic reduction as possible. As such, there is an increasing trend of surgical treatment of tibial shaft fractures, especially in the adolescent population. While properly done casting and immobilization are still carried out in appropriately selected tibial shaft fractures in the pediatric population, local data for radiographic and clinical outcomes of these non-surgically treated are yet to be explored. Objective: The primary objective of this study was to report residual lower limb deformity of tibial shaft fractures treated non-surgically in adolescents nearing skeletal maturity, identify factors or fracture characteristics that may predict these deformities, and report the clinical outcomes using the Lower Extremity Functional Scale. Methodology: A total of 31 adolescents nearing skeletal maturity at the time of injury with acute closed tibial shaft fractures treated non-surgically at the Philippine Orthopedic Center from 2017 to 2020 were included in the study. Radiographic analysis were done to evaluate skeletal maturity and residual sagittal & coronal angulation. Rotational alignment and leg length discrepancies were evaluated clinically. Functional outcome was measured with using the Lower Extremity Functional Scale (LEFS). Result: Coronal plane angulation (r=-0.397; p=0.05) and leg length discrepancy (r=-0.394; p=0.05) were shown to have significant inverse correlation with Lower Extremity Functional Scale (LEFS) scores. While sagittal plane angulation, tibial rotation, and fracture pattern were shown to have non-significant correlation. Significant correlation was also noted between presence of an ipsilateral fibular fracture and coronal plane angulation (p = 0.007). Lower Extremity Functional Scale (LEFS) scores ranged from 75 to 80 with a mean of 79.39. Conclusion: The radiographic and clinical outcomes of children nearing skeletal maturity with isolated acute tibial shaft fractures treated non-surgically showed that the current method of closed reduction and casting followed by close monitoring remains to be useful and effective.