Tibial fractures are a common pediatric fracture. Young children and toddlers are at risk for tibial shaft fractures, even when the force of injury is low. The diagnosis should be suspected in all children with a limp or refusal to bear weight.
Physical examination often allows localization of the fracture and should identify the presence of an open fracture or an acute compartment syndrome. Plain radiographs often suffice when assessing acute tibial injuries in children, but selected patients may require other forms of imaging. In patients with closed fractures and no sign of neurovascular compromise, initial management focuses on pain management, immobilization of the fracture, and reduction of swelling.
An overview of tibial fractures in children is presented here. The evaluation and management of specific types of tibial fractures in children is discussed separately. (See "Proximal tibial fractures in children" and "Tibial and fibular shaft fractures in children".)
Tibial fractures occur commonly in children. The mechanism of injury varies depending on the age of the patient. Low energy falls and twisting injuries account for most fractures in toddlers and younger children. High energy motor vehicle accidents and sports related injuries predominate in older children and adolescents (image 1). The high energy transmitted to the soft tissues surrounding the bone is relevant because of the risk for compartment syndrome associated with tibial fractures. (See 'Acute compartment syndrome' below.)
Most tibial shaft fractures are short oblique or transverse fractures of the middle or distal third of the shaft . Tibial shaft fractures are associated with fibula fractures in 30 percent of cases .