Tibial shaft fractures are among the most common pediatric long bone fractures. These fractures have significant implications for growth, function and alignment, often requiring precise management to prevent complications such as limb length discrepancies and angular deformities. This review focuses on the classification, etiology and management of pediatric tibial shaft fractures, emphasizing recent advancements and remaining challenges. A comprehensive literature review was conducted in November 2024 using PubMed, Medline and Scopus. Articles were selected based on relevance to etiology, classification and management strategies. Both recent and foundational studies were included to provide a comprehensive perspective. The review explores the major types of tibial shaft fractures in children, including Toddler’s fractures (and spiral fractures), transverse fractures, greenstick fractures, stress fractures, segmental fractures and comminuted fractures, focusing on their etiology, age-specific prevalence, clinical presentation, imaging findings, management strategies and potential complications. Younger children typically experience fractures due to low-energy mechanisms, such as twisting injuries, resulting in spiral or greenstick fractures. Older children and adolescents are more prone to high-energy trauma, causing transverse, comminuted or segmental fractures, often associated with fibular involvement. Most fractures are treated non-operatively using casting techniques tailored to fracture stability, angulation and age. Surgical interventions, including flexible intramedullary nailing, external fixation and plating, are reserved for complex or unstable fractures, open injuries or cases involving neurovascular compromise. Advances in classification systems, imaging modalities and surgical techniques have improved outcomes, yet opportunities exist to develop growth-preserving methods and improve long-term functional recovery. Future research should prioritize optimizing individualized management strategies and exploring innovative technologies to enhance diagnostic accuracy and treatment efficacy.
