Tibial shaft fracture in Child
Classic history and presentation: Pediatric patients with tibial shaft fractures typically present directly after trauma with visible lower leg deformity and inability to bear weight. Toddlers may present with a limp and refusal to bear weight without a distinguishable traumatic mechanism or limb deformity.
- Age – Lower leg fractures are most common in patients aged 10-14 years.
- Sex / gender – Pediatric tibial shaft fractures are more common in boys than girls.
Pathophysiology: The tibia is the primary load-bearing bone of the lower leg. Higher-energy mechanisms result in more complex fracture patterns, higher risk of concurrent fibular injury, and increased degrees of soft tissue damage. Axial loading may cause comminuted fractures. Low-energy rotational or torsional force more often results in spiral fractures.
Grade / classification system: Pediatric tibial shaft fractures have no formal classification system and are typically described based on fracture location (proximal, midshaft, distal) and pattern. Common patterns include incomplete (greenstick fractures), complete (transverse, oblique, etc), and spiral fractures (toddler's fracture).
S82.209A – Unspecified fracture of shaft of unspecified tibia, initial encounter for closed fracture
6990005 – Fracture of shaft of tibia
- Medial tibial stress syndrome
- Tibial stress fractures
- Tibial insufficiency fracture
- Fibular fracture
- Subperiosteal hematoma
- Bone tumor
- Acute compartment syndrome
- Compartment syndrome and vascular compromise are considered limb-threatening emergencies and need to be ruled out immediately.
- Open fractures are considered urgent, should receive irrigation and debridement within 6 hours, and should be started on prophylactic antibiotics immediately.
- Tibial shaft fractures in nonambulatory children, particularly in the presence of other physical findings suggestive of abuse, should receive a referral to Child Protective Services and a thorough child abuse workup.