Kevin J Setter1, Kathryn E Palomino. 1. Division of Hand and Upper Extremity Surgery, Department of Orthopedics, State University of New York at Syracuse, Syracuse, NY 13203, USA.
Abstract
PURPOSE OF REVIEW: Fracture of the tibia is a common occurrence in children. The operative treatment of pediatric tibia fractures has undergone a recent change. However, there is no clear consensus regarding the superiority of one treatment option. RECENT FINDINGS: The literature clearly supports the fact that the vast majority of pediatric tibia fractures can and should be managed nonoperatively. This is secondary to their inherent stability. A variety of factors including fracture type, location, severity and patient age determine the best treatment options for a particular fracture. A thorough understanding of these factors and how they affect outcome, help the clinician formulate the proper plan of treatment. SUMMARY: A randomized prospective controlled trial will be necessary to establish which surgical options are superior for which type of pediatric tibia fracture. Until then, recent studies have indicated that flexible intramedullary nails may lead to a shorter time to union and a decreased rate of refracture when compared with external fixation of unstable tibial shaft fractures. What remains unclear are the specific indications and contraindication for the use of flexible nails. External fixation still remains a successful treatment option for unstable tibial shaft fractures.
PURPOSE OF REVIEW: Fracture of the tibia is a common occurrence in children. The operative treatment of pediatric tibia fractures has undergone a recent change. However, there is no clear consensus regarding the superiority of one treatment option. RECENT FINDINGS: The literature clearly supports the fact that the vast majority of pediatric tibia fractures can and should be managed nonoperatively. This is secondary to their inherent stability. A variety of factors including fracture type, location, severity and patient age determine the best treatment options for a particular fracture. A thorough understanding of these factors and how they affect outcome, help the clinician formulate the proper plan of treatment. SUMMARY: A randomized prospective controlled trial will be necessary to establish which surgical options are superior for which type of pediatric tibia fracture. Until then, recent studies have indicated that flexible intramedullary nails may lead to a shorter time to union and a decreased rate of refracture when compared with external fixation of unstable tibial shaft fractures. What remains unclear are the specific indications and contraindication for the use of flexible nails. External fixation still remains a successful treatment option for unstable tibial shaft fractures.
Authors: Sauli A Palmu; Sampo Auro; Martina Lohman; Reijo T Paukku; Jari I Peltonen; Yrjänä Nietosvaara Journal: Acta Orthop Date: 2014-04-30 Impact factor: 3.717