Is Refracture a Concern Following Closed Management of Tibia Shaft Fractures in Children?

Tibia shaft fractures account for 15% of all pediatric fractures. These fractures are often treated nonoperatively with closed reduction and long leg casting. In children treated nonoperatively, refracture can cause significant frustration to both the patient and their family in addition to a delay in resuming normal activities for several months. The purpose of this study was to investigate the rate of refracture of tibia shaft fractures treated nonoperatively at our institution.

We performed a retrospective chart review of pediatric patients at one institution with the diagnosis of a tibia shaft fracture who were treated nonoperatively between January 1, 2000 and December 31, 2016. Exclusion criteria included those without complete retrievable radiographs or without radiographic confirmation of healed fracture. Patients who sustained a proximal or distal metaphysical tibia fracture or a toddler fracture were also excluded. Additionally, those with less than three months of clinic follow-up or an underlying metabolic bone disease were excluded. Data such as age, sex, body mass index, mechanism of injury, location of fracture, initial displacement, angulation, treatment, length of immobilization, and complications were recorded. The primary outcome for our study was the presence of refracture. Refracture was defined as a repeat fracture of the tibia at the same location within 18 months of the original fracture.

A total of 64 patients met the inclusion criteria and were included in the study. Of the 64 patients, only one patient sustained a refracture. The refracture occurred eight months after the initial injury and required operative intervention. This rate of refracture is equated to roughly 1.5%.

Conservative management of closed tibia shaft fractures with casting is an ideal treatment for pediatric fractures. Conservative management allows for avoidance of surgical intervention and low refracture rates. This study provides support regarding the adequacy of conservative management with limited complications. Although the rate of refracture still exists, patients and families should be counseled that the rate of healing without complications is about 98.5%.