Daniel Murphy1,2, Mohsen Raza3, Fergal Monsell4, Yael Gelfer3,5. 1. St George's University Hospitals NHS Foundation Trust, London, UK. danajmurphy@doctors.org.uk. 2. St George's, University of London, London, UK. danajmurphy@doctors.org.uk. 3. St George's University Hospitals NHS Foundation Trust, London, UK. 4. Bristol Royal Hospital for Children, Bristol, UK. 5. St George's, University of London, London, UK.
Abstract
AIMS: This review provides a summary of recent evidence surrounding the treatment of paediatric tibial shaft fractures and presents an algorithm to aid management of these injuries. This article reviews the relevant anatomy, epidemiology and aetiology of tibial shaft fractures and summarises contemporary treatment principles. Management recommendations and supporting evidence are given for fractures according to age (< 18 months, 18 months-5 years, 6-12 years, and 13-18 years). The relative merits of casting, plate fixation, elastic and rigid intramedullary nailing, and external fixation are discussed. Special attention is paid to the management of open tibial shaft fractures and to complications including infection and acute compartment syndrome. CONCLUSIONS: There has been a shift away from non-operative management of paediatric tibial shaft fractures over the last 30 years. However, recent evidence highlights that a non-operative approach produces acceptable outcomes when used in simple closed fractures at any age. Operative management may be indicated for unstable fractures where satisfactory alignment cannot be maintained or in specific circumstances including open injuries and polytrauma. Open injuries require urgent assessment by a combined orthopaedic and plastic surgery team at a specialist tertiary centre.
AIMS: This review provides a summary of recent evidence surrounding the treatment of paediatric tibial shaft fractures and presents an algorithm to aid management of these injuries. This article reviews the relevant anatomy, epidemiology and aetiology of tibial shaft fractures and summarises contemporary treatment principles. Management recommendations and supporting evidence are given for fractures according to age (< 18 months, 18 months-5 years, 6-12 years, and 13-18 years). The relative merits of casting, plate fixation, elastic and rigid intramedullary nailing, and external fixation are discussed. Special attention is paid to the management of open tibial shaft fractures and to complications including infection and acute compartment syndrome. CONCLUSIONS: There has been a shift away from non-operative management of paediatric tibial shaft fractures over the last 30 years. However, recent evidence highlights that a non-operative approach produces acceptable outcomes when used in simple closed fractures at any age. Operative management may be indicated for unstable fractures where satisfactory alignment cannot be maintained or in specific circumstances including open injuries and polytrauma. Open injuries require urgent assessment by a combined orthopaedic and plastic surgery team at a specialist tertiary centre.
Authors: Aristides I Cruz; Jeremy E Raducha; Ishaan Swarup; Jonathan M Schachne; Peter D Fabricant Journal: Curr Opin Pediatr Date: 2019-02 Impact factor: 2.856
Authors: Rebecca J Moon; Nicholas C Harvey; Elizabeth M Curtis; Frank de Vries; Tjeerd van Staa; Cyrus Cooper Journal: Bone Date: 2016-01-21 Impact factor: 4.398