Tibial Shaft Fractures In Children Research Articles

Treatment of Complex Tibial Fractures in Children with the Taylor Spatial Frame

Most tibial shaft fractures in children can be treated with closed reduction and cast fixation, but some fractures need external or internal fixation. The Taylor spatial frame (Smith & Nephew, Memphis, Tennessee) is a relatively new external fixator that can correct 6-axis deformities with computer accuracy. This article reports our experience using the Taylor spatial frame as a rewarding treatment modality for complex tibial fractures in children and adolescents.

Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: Preliminary results in 11 fractures

Elastic stable intramedullary nailing (ESIN) is used routinely world-wide for treating femoral and tibial shaft fractures in children before skeletal maturity. Overall, ESIN allows rapid limb mobilisation with few complications. However, many centres have experienced some complications resulting from secondary fracture displacement, especially in heavy adolescents and in spiroid or complex fractures due to changes in the nail's position, leading to limb shortening, malrotation and malalignment. End caps were designed by the AO expert group to address these complications. The purpose of this study is to evaluate the efficiency, safety and tolerance of this new device in our first series of ten patients and 11 fractures. Prospective follow-up of our first ten patients operated on with end caps. Our results show that there were no serious complications at a mean follow-up of 13.1 months. There was only one 10-mm leg shortening in a patient in whom the end caps could not be properly inserted. There were no infections, no additional pain and no skin irritation. The use of end caps eased the removal of the nails after bone healing, thereby preventing the formation of ossification over the tips of the nails and appeared to protect the skin next to the nail tip. These results seem to prove the advantage of using end caps when performing ESIN in lower limb shaft fractures in children. A longer follow-up that includes more patients and a randomised prospective study should be carried out in the future to determine more precisely the indications of this new device.

Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children

One thousand nine hundred and eighty-four children who had received conservative treatment for shaft (diaphyseal and metadiaphyseal) fractures of lower limbs (1162 femoral, 822 tibial fractures) at an average age of 8.5 years (range 0-14 years) were reviewed by clinical and radiographic investigations at an average follow-up of 6.6 years (1-15 years). Particularly, two main features were evaluated: remodelling of (angular and rotational) deformities and post-traumatic overgrowth. Mechanisms underlying these processes are discussed, based on a review of the literature, and parameters conditioning their evolution are analysed. Finally, criteria for an acceptable reduction (and limits for residual deformities that may be tolerated) at the time of conservative treatment are proposed.

Subatmospheric Pressure Dressings in the Temporary Treatment of Soft Tissue Injuries Associated With Type III Open Tibial Shaft Fractures in Children

This study was designed to evaluate the use of subatmospheric pressure dressings on high-energy open tibial shaft fractures in children. We hypothesized that the use of a negative-pressure dressing in these fractures would result in a decreased incidence of infection and decreased need for pedicled muscle flaps and free tissue transfer. A retrospective case series of 15 consecutive pediatric patients with 16 type III open tibial shaft fractures (8 type IIIA, 7 type IIIB, and 1 type IIIC). The patients' age ranged from 2 to 17 years. All patients underwent a standard protocol of serial irrigation and debridement of the open wound with bony stabilization. Temporary coverage of the open wound was obtained with the use of a subatmospheric pressure dressing until definitive wound coverage or closure. Infection occurred in 5 of 16 fractures, 2 requiring antibiotics alone (1 type IIIA and 1 type IIIB) and 3 requiring surgical intervention (2 type IIIB and 1 type IIIC). Seven of 16 (3 type IIIA, 3 type IIIB, and 1 type IIIC) fractures required repeat surgical intervention to facilitate bony healing. Only 3 patients required free tissue transfers or rotational muscle flaps for coverage, a 50% decrease compared with the initial classification. Compared with other described methods, the use of subatmospheric pressure dressings in the temporary treatment of soft tissue wounds associated with high-energy open tibial shaft may reduce the need for major soft tissue coverage procedures. Its effect on infection and fracture healing rates requires further study. A reduction in the need for major soft tissue coverage procedures with the use of negative-pressure dressings in this setting should result in decreased morbidity for these patients and in decreased social and financial costs.

Overgrowth Following TibialShaft Fractures in Children

Purpose : To assess the comparative growth of the four long bones of the lower extremities after the tibial shaft fractures in children. Materials and Methods : Thirty-eight children (age, 8.2±2.6) with tibial shaft fractures treated with a closed reduction and a long leg cast were enrolled in this study. The mean follow-up was 54.4 months (range, 24-96). The medical records and Bell-Thompson images were retrospectively reviewed. Results : The clinical results were excellent in all cases. The fractured tibia showed overgrowth (4.4±3.3 mm) compared with the contralateral side. The ipsilateral femur showed mild over- growth (0.9 mm±3.7), and the final leg length discrepancy was 5.3 mm±5.4. Four ipsilateral femurs showed overgrowth ＞10 mm. Gender, the level of the fractures and associated fibular fractures did not affect the overgrowth of the fractured tibia (p＞0.05). However, age might affect the amount of overgrowth (p=0.005). Conclusion : Tibial shaft fractures in children treated with a long leg cast showed variable overgrowth. The final leg length discrepancy was influenced by the overgrowth of the ipsilateral femur as well as by overgrowth of the tibia.

Treatment for tibial shaft fractures in children by minimally invasive plate osteosynthesis

Treatment for tibial shaft fractures in children by minimally invasive plate osteosynthesis

Problems of operative and non-operative treatment and healing in tibial fractures

Based on the experience of the department of pediatric surgery at the Strasbourg University Hospital, the authors present indications and limitations of various treatment techniques for tibial shaft fractures in children. Two retrospective series are reported on: one group of patients treated with the Sarmiento technique and one group of patients treated with Elastic Stable Intramedullary Nailing (ESIN or Métaizeau technique). The main problem in treatment is restoration of the mechanical axis of the tibia, especially in isolated fractures treated conservatively. Residual varus deformity is frequent, although it is usually within an acceptable range. ESIN has given better results than conservative treatment in this specific case, but valgus malunion shave been noticed when both bones were fractured, due to insufficient bending of the medial nail. ESIN is perfectly suited for treating polytrauma patients,especially those with multi level or open fractures (Gustilo 1 or 2), as it makes monitoring and nursing easier. Treatment of tibia fractures in children remains principally conservative. ESIN is indicated in cases of failure of conservative treatment, especially in isolated tibia fractures or polytrauma patients. For high grade open fractures (Gustilo 3)or extended comminuted fractures, external fixation remains the gold standard.

Cerclage percutané des fractures du tibia chez l'enfant. A propos de 34 cas

The results obtained by circumferential wiring of 34 fractures of the tibial shaft in children treated between 1958 and 1987 are reviewed. Of the patients treated, 22 were males and 12 were females. Their mean age was 13 (7 to 16) years. 26 fractures involved both the tibia and fibula, 8 were isolated tibial fractures; 26 fractures were closed and 6 were compound; 28 fractures were due to torsion, 6 were the result of bending. 22 patients required surgery for secondary displacement or inadequate reduction by traction, 6 for compound fractures. “Loose wiring” for minimizing periosteal damage was not found to be useful. Patients were immobilized in long-leg plaster casts for 11 weeks postoperatively; wires were removed after a mean interval of 12 weeks. Complications were absent throughout; infections and malunion were not seen. 14 patients were available for clinical and radiographic follow-up. Results of 12 patients with comparable torsion fractures and fracture management are reviewed: In these persistent lateral displacement was irrelevant; malalignment was negligible and did not require corrective surgery. The mathematical mean of leg shortening and lengthening was of greatest significance: It was found to be −1.3 (+8 AE −14) mm post-operatively and −2.5 (+8 AE −20) mm at the follow-up visit. If indicated, cerclage of tibial shaft fractures in children, which can be done percutaneously in most cases, is a safe procedure with few complications and excellent results. While complementary to conservative fracture management, it is not an alternative to it.

Intramedullary wiring for tibial shaft fractures in children before epiphyseal closure

Between 1958 and 1987 36 children underwent intramedullary wiring for tibial shaft fractures. Of these, 29 presented with combined tibial and fibular fractures, and 7 showed isolated tibial shaft fractures. Fractures were simple in 22 and compound in 14 patients. Mean patient age was 13 years (4-16 years). Only bending fractures with and without splinters were wired. The wiring technique and the protocol for postoperative care are reviewed. Mean immobilization time in long-leg casts was 12 weeks; intramedullary wires were removed after a mean interval of 17.7 weeks. Patients were selected for intramedullary wiring because of compound fractures of variable severity (14 patients), brain injuries with associated fractures (1), relative separation of the fracture ends with the fibula intact (2), severe dislocation or expected instability following closed reduction (9), and secondary dislocation or unsatisfactory alignment on skeletal traction (9). Complications included infections of 2nd degree compound fractures (2 patients), transitory peroneal palsy (2) and delayed union (2). Non-union and damage related to immobilization were not seen. A total of 19 patients were available for follow-up. Mean follow-up time was 9 years. Posttreatment lateral displacement was found to be irreversible except in infants but had no functional relevance. Malalignment showed a tendency towards spontaneous correction, which decreased with increasing age. Correction surgery proved to be unnecessary. Differential longitudinal growth was not consistently evaluable because of the heterogeneity of the material; reported data on this parameter from the literature were equally inconclusive.(ABSTRACT TRUNCATED AT 250 WORDS)