Isolated Tibial Diaphysis Fractures

An isolated tibial fracture with an intact fibula is the most common tibial fracture pattern seen in children. Displaced fractures can be difficult to reduce because of the splinting effect created by the intact fibula. In addition, the splinting effect of the fibula is though to produce a bending moment that results in varus angulation on healing.

Discussion on whether or not the presence of an intact fibula results in delayed union with non-operative management has been made irrelevant, as the overwhelming majority of surgeons prefer to treat both low-energy and high-energy closed fractures of the tibial diaphysis with intramedullary nailing.

References

• Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P 3rd, Hanson B, Weaver B, Sprague S, Schemitsch EH. Surgeons' preferences for the operative treatment of fractures of the tibial shaft. An international survey. J Bone Joint Surg Am. 2001 Nov;83-A(11):1746-52.
• O'Dwyer KJ, DeVriese L, Feys H, Vercruysse L. Tibial shaft fractures with an intact fibula. Injury. 1993 Oct;24(9):591-4.
• Sarmiento A, Sharpe FE, Ebramzadeh E, Normand P, Shankwiler J. Factors influencing the outcome of closed tibial fractures treated with functional bracing. Clin Orthop Relat Res. 1995 Jun;(315):8-24.
• Yang JP, Letts RM. Isolated fractures of the tibia with intact fibula in children: a review of 95 patients. J Pediatr Orthop. 1997 May-Jun;17(3):347-51.