Tibial Shaft Fractures in Children: What to Do When Casting Fails?

Tibial shaft fractures in children can often be successfully managed with a well-molded cast that controls length, alignment, and rotation of the fracture. Acceptable alignment of tibial shaft fractures in children is less than 10° of coronal and sagittal angulation, 50% translation, and 10 mm of shortening. Fractures of the tibial shaft without an associated fibular shaft fracture may fall into varus malalignment despite initial adequate reduction and should be followed closely during the first 3 weeks after injury. Surgical treatment should be considered in adolescent patients and those with open fractures, comminuted fractures, and fractures that cannot be adequately reduced and stabilized with a cast. The predominant modes of surgical stabilization of tibial shaft fractures in children are external fixation or internal fixation with flexible intramedullary nails or via minimally invasive plate osteosynthesis; both methods have reliable results.