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Displaced Tibial Shaft Fractures With Intact Fibula in Children: Nonoperative Management Versus Operative Treatment With Elastic Stable Intramedullary Nailing

Canavese, Federico MD, PhD; Botnari, Alexei MD; Andreacchio, Antonio MD; Marengo, Lorenza MD; Samba, Antoine MD; Dimeglio, Alain MD; Pereira, Bruno PhD; Mansour, Mounira MD; Rousset, Marie MD

doi: 10.1097/BPO.0000000000000528

Background: The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibial shaft fractures with intact fibula in children after nonoperative management and operative treatment by elastic stable intramedullary nailing.

Methods: A study was performed on 80 consecutive children, 56 males, 24 females from 2 Institutions, with displaced and closed tibial shaft fracture with intact fibula. All patients underwent regular clinical and radiographic follow-up visits for at least 2 years after injury.

Results: In total, 26 patients (group A-Institution I) were treated surgically by elastic stable intramedullary nailing and 54 patients (18 patients from group B-Institution I and 36 patients from group C-Institution II) were treated nonoperatively with closed reduction and casting. groups A, B, and C did not significantly differ on sex (P=0.37), side (P=0.54), and fracture site (P=0.14).

Valgus deformity was significantly controlled in group A patients only (P=0.001); during follow-up in group B patients (P=0.017), and showed no significant change between pretreatment images and last follow-up in group C patients (P=0.71). Procurvatum deformity was significantly controlled in group A patients only (P=0.001); it showed no significant improvement after conservative treatment in group B (P=0.73) and C patients (P=0.8). Recurvatum was significantly improved in group A (P<0.001) and C patients (P<0.001) but remained unchanged in group B patients (P=0.15). Varus deformity improved significantly in all patient groups.

Immobilization time was significantly shorter in group A compared with group B and C patients (P<0.001).

However, numerical differences, although statistically significant, were not clinically relevant for all variables but immobilization time.

Conclusions: This study showed good functional and radiologic outcomes in the pediatric population who had sustained closed, traumatic, displaced fracture of tibial diaphysis without associated fibula fracture.

On the basis of the findings reported here, it is not contraindicated to operate skeletally immature patients with displaced fracture of tibial diaphysis without associated fibula fracture. However, results were essentially the same and either method is a satisfactory choice for pediatric tibia shaft fractures with an intact fibula. In particular, we found that conservative treatment was as efficacious as surgical treatment apart from the length of time for immobilization.

Level of Evidence: Level III.

*Pediatric Orthopedic Department, Estaing University Hospital

§Biostatistics Unit, DRCI, Estaing University Hospital, Clermont-Ferrand

Faculty of Medicine, Montpellier University, Montpellier, France

Pediatric Orthopedic Department, Regina Margherita Children’s Hospital, Turin, Italy

None of the authors received financial support for this study.

The authors declare no conflicts of interest.

Reprints: Federico Canavese, MD, PhD, Pediatric Orthopedic Department, Estaing University Hospital, 1, Place Lucie et Raymond Aubrac, Clermont-Ferrand 63003, France. E-mail:

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