A Comparison of Two Approaches for the Closed Treatment of Low-Energy Tibial Fractures in Children

Silva, Maurício; Eagan, Michael; Wong, Melissa; Dichter, Daniel H.; Ebramzadeh, Edward; Zionts, Lewis E.

doi:10.2106/jbjs.j.01728

Cited by 20 publications

(16 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This differentiates our patient population from other recent studies looking at the management of tibia fractures in the pediatric population. Silva et al 15 randomized 81 children with low-energy tibial shaft fractures to 1 of 2 groups-long-leg cast immobilization with initial non-weight-bearing and long-leg cast immobilization with weight-bearing as tolerated-and found no increased risk of angulation or shortening at the fracture site with early weightbearing. Notably, the average prereduction angulation in their study was 1.3 degrees in the coronal plane and 0.7 degrees in the sagittal plane, significantly lower than the initial angulation seen in our cohort (5.1 and 4.2 degrees, respectively).…”

Section: Discussionmentioning

confidence: 99%

Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents

Kinney

Nagle²,

Bastrom³

et al. 2016

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents

Kinney

Nagle²,

Bastrom³

et al. 2016

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…However, it has been the authors' experience that older children with a closed tibial shaft fracture can be prone to delayed union and incomplete healing, which may lead to prolonged restrictions from activities and sports. Whereas flexible nail fixation has increased in popularity for the treatment of these fractures [2][3][4][5], significant complications such as compartment syndrome, malunion, nonunion, and nail migration have been reported [6,7], and casting currently remains the mainstay of treatment at most institutions [8]. The purpose of this study was to analyze success and failure of cast treatment for closed tibial diaphyseal fractures in the adolescent population.…”

Section: Introductionmentioning

confidence: 99%

Tibial shaft fractures in adolescents

Dammann

Podeszwa³

et al. 2015

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

This study retrospectively analyzed cast treatment of 75 adolescent closed tibial diaphyseal fractures. The average age was 13.3 years (range, 10-17.4 years). Of the patients, 21% (16/75) required cast change/wedging in the clinic for loss of reduction, and three patients (4%, 3/75) injured in vehicular collisions had failure of cast treatment, requiring an unplanned surgical intervention. Initial and immediate postreduction radiographic deformities were greater (P<0.05) in patients who required cast change/wedging. Of the patients, 59% (44/75) required over 3 months of cast immobilization. Casting is successful in the majority of adolescent patients despite prolonged immobilization and the need for cast change/wedging.

show abstract

“…Length of immobilization was provided in six studies (n ¼ 604). 5,10,11,14,15,18 There was great variation in immobilization times among nonoperatively treated patients, and the mean immobilization ranged from 4.9 to 17.4 weeks. The weighted average immobilization was 8.5 weeks.…”

Section: Treatmentmentioning

confidence: 99%

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Stenroos

Puhakka

Nietosvaara³

et al. 2019

Eur J Pediatr Surg

View full text Add to dashboard Cite

Tibia fractures are among the most common long-bone fractures in children. Despite this, there is no current consensus on the optimal treatment strategy for closed displaced tibia shaft fractures in the pediatric patient population. The aim of this study is to compare the reported complications and outcomes of reduction and cast immobilization versus flexible intramedullary nailing in the treatment of pediatric tibia shaft fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this prospectively registered systematic review. Eleven studies were included. Quality of the studies was assessed using the Coleman methodology score. Mantel–Haenszel cumulative odds ratios were used to compare the risk of complication between different methods of treatment. Eleven studies including 1,083 patients with diaphyseal fractures of the tibia met the inclusion criteria. The most common fracture type was simple 42-A (782; 91%). Majority (75%) of the patients were treated nonoperatively. The total complication rate was higher among operatively treated patients (24 vs. 9%; p < 0.05). Satisfactory fracture alignment had to be restored surgically in 5% of the primarily nonoperatively treated patients. The evidence levels of the included studies were II (1), III (2), and IV (7). Three-fourths of closed diaphyseal fractures of the tibia in children are still treated with reduction and cast immobilization. Flexible intramedullary nailing is associated with significantly higher complication rate than nonoperative treatment.

show abstract

A Comparison of Two Approaches for the Closed Treatment of Low-Energy Tibial Fractures in Children

Abstract: Children with low-energy tibial shaft fractures can be successfully managed by immobilizing the knee in 10° of flexion and encouraging early weight-bearing, without affecting the time to union or increasing the risk of angulation and shortening at the fracture site.

Cited by 20 publications

References 16 publications

Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents

Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents

Tibial shaft fractures in adolescents

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About