Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

Abstract

Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg.Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy.Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.

Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital

“…Post-operative issues increase the length of hospital stay [24], with significant financial relevance and patients' mental and health well-being issues, especially in children. Patients' length of stay in this series (both casting and surgery) is comparable to the results reported by Weber et al [9].…”

“…However, surgical management is sometimes appropriate based on patient characteristics and fracture patterns [7]. Improvement and innovation in surgical techniques, a drive to reduce hospital stays and early mobilization for rehabilitation are also factors influencing surgical decisions [8,9]. This study's objective is primarily to evaluate the management of displaced tibia shaft and metaphyseal fractures in children.…”

Fraturas na criança: Estamos ficando mais cirúrgicos?

“…Weber et al 44 reported that, among 168 tibia fractures in children treated in the emergency room between 2005 and 2017, 38 were surgically treated, 36 of which were fixed with flexible rods or plate and two stabilized with external fixator. The mean age of the patients treated conservatively was statistically lower (6 years old) when compared to that of the operated patients (10.2 years old).…”

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

“…Both bones are broken in 30% of patients, and isolated fibular fractures are rare [ 3 ]. According to the type, the transverse or short oblique fractures of the tibia are most commonly seen [ 4 , 5 ]. The tibia is most susceptible to trauma in the area of transition from the middle to the distal third due to anatomical changes in the cross-section of the bone from triangular to round in shape [ 6 ].…”