Tibial shaft fracture in Child
Alerts and Notices
Synopsis
Causes / typical injury mechanism: Tibial shaft fractures in children often occur as a result of low-energy rotational forces on the lower leg, typically due to pivoting or direct trauma with the foot planted, producing isolated tibial fractures with spiral patterns. High-energy trauma may produce transverse fractures (frequently including the fibula), oblique fractures, or comminuted fractures, depending on the axis and magnitude of the forces involved. Particularly high-energy events may result in segmental fractures and extensive soft tissue injury, putting patients at a high risk for compartment syndrome.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.
Prevalence:
- 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).
Codes
ICD10CM:S82.209A – Unspecified fracture of shaft of unspecified tibia, initial encounter for closed fracture
SNOMEDCT:
6990005 – Fracture of shaft of tibia
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Differential diagnosis:- 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.
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References
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Last Reviewed:01/18/2021
Last Updated:01/21/2021
Last Updated:01/21/2021