Tibial shaft fractures are the third most common long bone fracture in children and are accompanied by a fibular shaft fracture in 30 percent of patients. Physical examination should carefully assess for the presence of an open fracture or signs of acute compartment syndrome. Most fractures are nondisplaced and may be managed with immobilization and orthopedic follow-up.
The evaluation and management of pediatric tibial and fibular shaft fractures will be reviewed here. The general approach to tibial fractures, care of proximal tibial fractures in children, and stress fractures of the tibia and fibula are discussed separately. (See "Overview of tibial fractures in children" and "Proximal tibial fractures in children" and "Stress fractures of the tibia and fibula".)
Tibial shaft fractures are the third most common fractures in children, after fractures of the femur and forearm . The mechanism varies depending on the age of the patient, with low energy falls and twisting injuries being more common in younger children and high energy motor vehicle accidents and sports-related injuries predominating in older children and adolescents (image 1). The high-energy transmitted to the soft tissues surrounding the bone is relevant because of the significant risk for compartment syndrome associated with tibial shaft fractures. Thus, special attention should be paid to neurovascular status in the first 24 hours following such injuries. Open fractures, most commonly caused by vehicular related injury, are also a major concern with tibial shaft fractures because the anterior tibia is very close to the skin surface.
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 . The average age at injury is eight years, and it is more common in boys than girls [2,3].
The tibia is the major weightbearing bone of the lower leg (picture 1 and picture 2). The proximal portion of the bone, the tibial plateau, forms the lower surface of the knee joint. The distal end of the bone forms the superior articular surface of the ankle joint at the tibiotalar articulation and the medial malleolus. The tibial shaft bridges the proximal and distal ends and its anterior surface lies just below the skin.