pediatric distal tibia fracture
Epiphyseal fractures of the distal ends of the tibia and fibula. Fracture of the lateral portion of the distal tibial epiphysis. In more severe cases, the tibia bone may protrude through the skin. (2)2 Department of Orthopedics, Humanitas Research Hospital, Milan, Italy. Telephone: 410.494.4994, Salter-Harris Type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus, Distal tibial physeal fractures in children that may require open reduction, Fracture of the lateral portion of the distal tibial epiphysis, Pediatric Extra-Octave Frx of Proximal Phalanx, Orthopaedic Specialists of North Carolina. boys > girls; average age of occurrence - … Copyright © 2021 Lineage Medical, Inc. All rights reserved. Ankle Salvage Following Nonunion of Distal Tibia Fractures. What is the most appropriate management? "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation. A toddler's fracture is The child is afebrile and exam reveals tenderness along the distal tibial shaft with no significant swelling. Initial x-rays commonly do not show evidence of Toddler’s Fracture (13-43%). Distal tibial physeal fractures in children that may require open reduction. )**, (OBQ09.141)
On physical exam the leg has no erythema, but does have mild tenderness along the distal tibial shaft. If despite multiple views, no fracture can be identified, follow-up radiographs usually will demonstrate slight sclerosis and periosteal reaction. ... Harris type III fracture of the distal tibia. Towson, MD 21204
All patients were followed up until symmetric growth was noted (by Harris growth lines) for a minimum of 1 year or until physiologic closure of the growth plates had been documented radiographically. Fractures of the distal tibial metaphysis have been only described in fracture texts without reference to a peer-reviewed study. Fracture of the lateral portion of the distal tibial … Pediatric Tibial Fractures. The mechanism of … Author information: (1)1 Department of Orthopedics, Menaggio Hospital, Menaggio, Italy. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Radiographs are shown in Figure A and B. H However, distal tibia skin and soft tissue coverage is relatively poor in children, and the blood supply to the bone is not abundant. Plain radiographs are negative. The cause of these injuries is frequently violent, and… These fractures are usually transverse (across) or oblique (slanted) breaks in the bone. Other pediatric fractures of the tibia or fibula are discussed separately. Often as a result of minor mechanism, many times with a rotational component. Most pediatric tibia/fibula fractures can be treated with a long-leg cast, which achieves good outcomes after 6 to 8 weeks. Pediatric Tibial Fractures. Distal Leg Fractures. A 2-year and 11-month old child fell while playing with friends 2 hours ago and has avoided bearing weight on the right leg since that time. pathoanatomy of pediatric ankle fracture patterns. Epiphyseal fractures of the distal ends of the tibia and fibula. 110 West Rd., Suite 227
pediatric tibial shaft fractures are the third most common long bone fracture in children . Acute pain management; Open fractures require immediate IV antibiotics and urgent surgical washout Tibial plateau fracture; Tibial shaft fracture; Pilon fracture; Maisonneuve fracture; Tibia fracture (peds) Ankle fracture. A 23-month-old girl refuses to bear weight since falling on the playground yesterday. Internal oblique projection can better demonstrate the fracture in some cases 8. 10.1055/b-0036-129629 Distal Tibia Fractures Sean E. Nork Fractures of the distal tibia are among the most difficult injuries facing the orthopaedic traumatologist. Tibia fractures represent the third most common pediatric long bone fracture, after femur and forearm fractures. DEFINITION. Acquired valgus deformity of the tibia in children. Fractures of the Distal Tibial Metaphysis These involve about half of all pediatric tibial fractures. Fracture is not displaced. Paired bones. In many of these cases, a cast is used for treatment. Craig P. Eberson. treatment is usually nonoperative with long leg casting but is tailored to the injury type and patient age; Epidemiology . Surgical Indications for Distal Tibial Epiphyseal Fractures in Children, Clifford R. Wheeless, III, M.D. An intramedullary strategy is a commonly employed technique for tibial fracture fixation in children as it confers a bridge fixation with a long working length and encourages callus formation [4, 5, 9]. A Triplane Fracture of the Distal Tibia Complicated by Dislocation of the Fibula 17 November 2016 | Foot & Ankle International, Vol. 28, No. Distal tibial physeal fractures are classified by the Salter-Harris classification.They can also be classified by the indications. A retrospective study of two hundred and thirty-seven cases in children. Although both extra-articular and intra-articular patterns occur with varying severity, the common concern in all of these injuries is the associated soft tissue injury. pediatric tibial shaft fractures are the third most common long bone fracture in children, treatment is usually nonoperative with long leg casting but is tailored to the injury type and patient age, 39% of tibia fractures occur in the mid-diaphysis, most commonly due to pedestrian vs vehicle (50%), torsional forces result in a spiral or oblique fracture pattern or a "toddler's fracture", • greenstick fracture of the tibia and/or fibula, • complete fracture of the tibia with or without ipsilateral fibula fracture or plastic deformation, Tibial spiral fracture (Toddler's Fracture), nondisplaced spiral or fracture of the tibia with intact fibula in a child under 2.5 years of age, AP and lateral views of the tibia and fibula are required, ipsilateral knee and ankle must be evaluated, open or closed tibial shaft fractures in patients at or near skeletal maturity, extend cast to the groin with the knee flexed to 30 degrees and appropriate molding, drill holes are made in the proximal or distal tibial metaphysis, flexible rods are introduced into the proximal or distal tibial metaphysis and passed across the fracture site, typically a short period of immobilization and non-weight bearing given flexibility of nails, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease), 30% are associated with a fibula fracture, second most common fractured bone following nonaccidental trauma, triangular shaped bone with apex anteriorly that broadens distally, tibial flare distally leads to primarily cancellous bone and a thin cortical shell, the anterior and lateral compartment musculature produce valgus deforming forces when both the tibia and fibula are fractured, posterior tibial a. provides nutrient and periosteal vessels, the anterior tibial artery is vulnerable to injury as it passes through the interosseous membrane, the fibula bears 6-17% of the weight-bearing load, Classification based on fracture location (proximal, midshaft, distal) and pattern, radiographs may appear normal in toddler's fractures, concern for physeal or intra-articular extension, pathologic lesion, distal third tibia fractures may propagate to physis or articular surface, suspicion for pathologic or stress fracture, follow up x-rays in 2 weeks to evaluate for callus in order to confirm the diagnosis in equivocal cases, < 5-10 degrees of angulation in the sagittal and coronal planes, mold cast to decrease likelihood of fracture displacement, complete fractures with intact fibula tend to fall into varus, complete fractures with fracture fibula tend to fall into valgus and recurvatum, serial radiographs are performed to monitor for developing deformity, serial followup if physeal extension to monitor for growth disturbance, open or closed fractures with extensive soft tissue injury, length unstable fractures, or poly-trauma patients, open or closed fractures in skeletally immature patients, multiple long bone fractures or floating knee, noncomminuted, unstable oblique fractures, open or closed fractures with physeal or articular extension, may be corrected with opening or closing cast wedging, if open fracture debride and irrigate prior to placing pins, 2 half-pins above and below fracture in the tibia, less common than adult tibial shaft fractures, iatrogenic pin placement may lead to growth arrest or recurvatum from tibial tubercle arrest, symptomatic and at risk of joint degeneration, hypertrophic: bone grafting and rigid fixation, oligotrophic or atrophic: bone grafting and fixation, +/- resection.