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Modern management of paediatric tibial shaft fractures: an evidence-based update

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Aims

This review provides a summary of recent evidence surrounding the treatment of paediatric tibial shaft fractures and presents an algorithm to aid management of these injuries.

Summary

This article reviews the relevant anatomy, epidemiology and aetiology of tibial shaft fractures and summarises contemporary treatment principles. Management recommendations and supporting evidence are given for fractures according to age (< 18 months, 18 months–5 years, 6–12 years, and 13–18 years). The relative merits of casting, plate fixation, elastic and rigid intramedullary nailing, and external fixation are discussed. Special attention is paid to the management of open tibial shaft fractures and to complications including infection and acute compartment syndrome.

Conclusions

There has been a shift away from non-operative management of paediatric tibial shaft fractures over the last 30 years. However, recent evidence highlights that a non-operative approach produces acceptable outcomes when used in simple closed fractures at any age. Operative management may be indicated for unstable fractures where satisfactory alignment cannot be maintained or in specific circumstances including open injuries and polytrauma. Open injuries require urgent assessment by a combined orthopaedic and plastic surgery team at a specialist tertiary centre.

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Authors and Affiliations

  1. St George’s University Hospitals NHS Foundation Trust, London, UK

    Daniel Murphy, Mohsen Raza & Yael Gelfer

  2. St George’s, University of London, London, UK

    Daniel Murphy & Yael Gelfer

  3. Bristol Royal Hospital for Children, Bristol, UK

    Fergal Monsell

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  1. Daniel Murphy
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  2. Mohsen Raza
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  3. Fergal Monsell
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Correspondence to Daniel Murphy.

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Murphy, D., Raza, M., Monsell, F. et al. Modern management of paediatric tibial shaft fractures: an evidence-based update. Eur J Orthop Surg Traumatol 31, 901–909 (2021). https://doi.org/10.1007/s00590-021-02988-0

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