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Paediatric Tibia & Fibula

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Tibial shaft fractures: Third most common long bone fracture in children and adolescents.  

30% are associated with fibula fracture

Non displaced spiral fractures common in young children.

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TIBIAL SHAFT FRACTURE MANAGEMENT

  • Analgesia

  • Acceptable reduction parameters

    • <8 years​

      • Angulation 10 degrees

      • rotation 10 degrees

      • shortening 10mm

      • apposition 0%

    • >8 years​

      • Angulation 5 degrees​

      • Roation 5 degrees

      • shortening 5mm

      • apposition 50%​

  • Above knee backslab​

  • Fracture clinic

CLASSIFICATION

  • Open/Closed

  • Tibia, Fibula or both

  • Fracture location- proximal or distal, metaphyseal or diaphyseal

  • Fracture pattern- transverse, spiral, butterfly, comminuted

  • Involvement of Growth Plates

REFER ORTHO IF:

  • Open fracture

  • Displaced fracture

  • Neurovascular injury

  • Significant swelling/compartment syndrome.

  • Other fracture same limb.

ISOLATED FIBULA FRACTURE

  • Direct blow mechanism

  • Immobilize as needed for comfort(fibula 15% of weight bearing)

  • Carefully assess ankle (r/o Maissenouve injury- widened ankle mortise)

  • Fracture Clinic follow up

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