Isolated tibial fractures in children.

In a review of 65 tibial fractures in children of which 25 were isolated and not associated with a fracture of the fibula, we found that isolated tibial fractures were not uncommon, and accounted for one-third of all tibial fractures in children under 11 years of age. They occur after two types of force, the most common being indirect violence involving a torsional injury. Isolated fractures unite easily without delayed union. Isolated transverse fractures never displace, and consequently do not require further radiographs following the initial check radiograph after the application of the plaster cast. In seven of the 25, the fracture was spiral or oblique and displacement into varus occurred for up to 2 weeks after the initial injury. These need careful follow-up, with weekly radiographs for the first 2 weeks. If the varus displacement is greater than 5 degrees we recommend manipulation in that period. After this time the fracture site is sticky, and manipulation will fail. Non-operative treatment is recommended for this fracture.