[Pediatric tibial fractures: is conservative therapy still currently appropriate?]

Leg-length inequality is the most common complication reported after pediatric tibial fractures. We reviewed 196 patients with tibial fractures. The mean age at the time of fracture was 7.6 years (range 10 months-12 years). In all, 176 patients were treated conservatively, 162 by immediate cast bracing and 14 by skeletal traction. In 20 patients the fracture was stabilized by osteosynthesis. Thirteen patients were treated by plate fixation; in 4 fractures located in the distal third of the tibia, we used crossed Kirschner wires. In one case we used a screw osteosynthesis; another distal fracture was stabilized by a fibula rushpin, and in one third-degree open fracture an arthrodesis of the upper ankle joint was necessary. A total of 71 patient were interviewed and examined. All were skeletally mature at the time of reexamination. A leg-length discrepancy was found in 40 patients. Shortening of 5-15 mm had occurred in 11 patients; 29 patients had experienced lengthening of 5-20 mm. In 21 patients, leg-length discrepancy was more than 5 mm (13 had lengthening of 10-20 mm, 8 had shortening of 10-15 mm). Leg-length discrepancy was significantly higher in patients younger than 10 years (P = 0.024, chi 2-test according to Pearson). The number of repositions also played an important role (1 or more; P = 0.006). With fibula involvement, leg-length discrepancy was significantly higher (P = 0.018). Both factors indicate the grade of fracture instability. The authors conclude that conservative treatment of pediatric tibial fractures is still appropriate. However, instable fractures as well as fractures in children > 10 years of age should be operated upon primarily.