These form the endosteal vascular tree, which anastomoses with the periosteal vessels arising from the anterior tibial artery. 6 The posterior tibial artery gives rise to the nutrient artery, which enters the posterolateral cortex, giving off ascending and descending branches. The anteromedial aspect of the tibial is subcutaneous with no overlying musculature for protection and the middle/distal tibia has no muscular origins, which can delay union in these areas. Nevertheless, the rare occurrence of malunion, nonunion, growth arrest, and compartment syndrome are important complications. Overall, outcomes are good because of the healing and remodeling potential of pediatric patients. Operative options are used uncommonly and will be discussed in this paper.
FIBULA SPIRAL FRACTURE HEALING TIME FULL
In the acute high-velocity trauma setting, the child must be managed according to full pediatric trauma protocol, with initial splinting. It is predominantly nonoperative with closed reduction and casting, requiring close followup. Management of pediatric tibial shaft fractures is individualized based on age, co-existing injuries, and associated soft tissue and neurovascular injury. Child abuse is an important consideration as the tibia is the second most common fractured bone and 26% of abused children have a tibial fracture, 5 although more so apophyseal ring or metaphyseal corner fractures. Rarely, isolated fibula fractures occur, usually following direct trauma.
The tibia is the third most common fracture after the femur and humerus in polytrauma pediatric patients. Direct traumas such as pedestrian versus vehicle account for 50% of the ipsilateral tibia and fibula fractures, 2 which can result in valgus malalignment. Older children, aged 4–14 years, usually suffer from indirect sporting injuries or direct injury from motor vehicle trauma – either a crash or pedestrian struck. The fibula is usually intact in these fractures, preventing shortening but risking varus malalignment. 4 In younger children, aged 1–4 years, most tibial shaft fractures occur from falls or torsional forces as the body rotates on a planted foot, causing spiral, and oblique fractures. 2, 3 The average age of occurrence is 8 years, with males affected twice as often as females. 1 Of these, approximately 39% occur in the middle third, and 30% are associated with fibula fracture. Pediatric tibial fractures are the third most common pediatric long bone fracture after the femur and forearm, representing 15% of all pediatric fractures. Complications are uncommon but include deformity, growth arrest, nonunion, and compartment syndrome. This includes flexible intramedullary nailing, Kirschner wire fixation, external fixation, locked intramedullary nailing, and plating. Although there is potential for remodeling, this may not be adequate with more significant deformities, thus requiring remanipulation or rarely, operative intervention. Treatment is predominantly nonoperative with closed reduction and casting, requiring close clinical and radiological followup until union. Child abuse must always be considered in a nonambulatory child presenting with an inconsistent history or suspicious concomitant injuries. In addition to acute fracture, Toddler's and stress fractures are important entities. Diagnosis is clinical and radiological, which can be difficult in a young child or with minimal clinical findings. They require appropriate diagnosis and treatment to minimize complications and optimize outcomes. Tibial shaft fractures are one of the most common pediatric fractures.
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