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Tibial Diaphyseal Fractures in Children: Case Study

Tibial diaphyseal fractures are common among younger patients, and when treated through traditional methods, the results are often positive.

Orthopedic doctors should consider several factors when dealing with fractures, such as age, place of affection, type of fracture and therapy. When submitted to angular impacts, the anatomical advantage of a thicker periosteum and flexibility may be an advantage.

Stabilization surgery for adolescents has become a trend in the orthopedic and traumatology fields due to the greater severity and complexity of fractures in that age group. Infection, delayed union and non-union, frequent fractures complications in adults, are much less common in children.

Tibia fractures in children and adolescents are the most common lower-extremity fractures. Among the pediatric population, they represent 10 to 15% of all fractures. With closed treatment, they recover more quickly and present few complications, such as delay in consolidation and pseudarthrosis.

Tibial diaphyseal fracture in children is the most common if they are still learning to walk – it is a result of low-energy trauma, causing fractures with smaller deviations than in adolescents. Bone resistance to direct impact trauma and torsional trauma tends to increase with age.

How to prepare a child for surgery?

High-energy trauma fractures are most common in adolescents – it is at this age that fractures with tibia and ipsilateral fibular displacement come together with soft tissue injuries and, as a result, treatment becomes more complex and the prognosis is influenced.

The peak of affection of tibial fractures occurs, on average, at the age of 8.

Approximately 6 to 10% of tibia fractures are exposed70% of them occur in an isolated manner, while 30% are associated with ipsilateral fibular fracture. This bone is also the second most frequently fractured bone in beaten children, about 26% of fractures in these children are of the tibia – a scary percentage when you think about it.

Fractures of the diaphysis of the tibia or fibula represent approximately 4 to 5% of all pediatric fractures. These fractures are divided into 3 categories:

  • Without deviation;
  • Oblique or spiral;
  • Transverse and comminuted with deviation.

The tibia has limited remodeling potential. However, the deformity in external rotation is better tolerated than in internal rotation.

Babies and infants can correct around 50% of the post-fracture residual angulation and, in children up to 10 years old, there is an improvement of the poor axial alignment in 25% of the cases.

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