Tibia Fractures in Children

Fractures of the tibia, also called the shinbone, are a common injury in children. A crack or break in the tibia is referred to as a tibial fracture. Most breaks usually occur in the middle of the tibia or “tibial shaft”, known as a tibial shaft fracture. A break in the top section of the tibia is known as a proximal tibia fracture, whereas a break in the bottom section of the tibia is known as a distal tibia fracture.

The lower leg is made up of two long bones called the tibia and fibula that extend between the knee and ankle and help form the ankle joint and knee joint. The tibia or shinbone is the larger of the two bones and is one of the major bones of the lower leg. It bears most of the body’s weight and plays a crucial role in balancing body weight when standing and walking. The tibia is the most frequently fractured long bone of the body even though it takes a great amount of force for a fracture of the tibia to occur.

Types of Tibia Fractures

Tibia fractures in children vary depending on the force involved and are classified into different types based on the location of the fracture, pattern of the fracture, and exposure of the fracture site.

Some of the types of tibia fractures that children can sustain include:

Transverse fracture: In this fracture, the break occurs as a straight, horizontal line going across the tibial shaft.

Oblique fracture: In this type, the break occurs as an angled line across the tibial shaft.

Comminuted fracture: A severe type of fracture where the tibia breaks into 3 or more pieces.

Spiral fracture: A type of fracture caused by a twisting force with a fracture line that encircles the tibia.

Open fracture: This is also known as a compound fracture and causes serious damage to the surrounding soft tissue structures as the tibial shaft fragments protrude out through the skin to the external air, exposing the fracture site.

Stress fracture: Also called a hairline fracture, this fracture appears as small thin cracks in the bone and occurs due to overuse or wear and tear.

Causes

Some of the common causes of tibia fractures in children include:

• Falls
• Twisting injuries
• Direct hit to the bone
• High-energy trauma, such as sports injuries or motor vehicle accidents

Signs and Symptoms

Some of the common signs and symptoms of tibia fractures in children include:

• Severe pain in the tibia
• Inability to bear weight on the leg
• Swelling or bruising
• Numbness or tingling
• Difficulty walking
• Deformity or instability in the leg

Diagnosis

To diagnose a tibial fracture in children, your child’s pediatric orthopedist will review their symptoms and medical history and conduct a thorough physical examination. To identify the type and severity of the fracture, your doctor will order imaging studies such as X-rays, CT scan, MRI or a bone scan.

Treatment

The treatment approach for tibial fractures in children depends upon the type and severity of the fracture and involves both nonsurgical as well as surgical methods.

Non-surgical methods

• Casting and splinting: If your child’s tibia fracture is not too serious and the bone is correctly positioned, your physician may place the affected leg in a cast or splint until the bone heals satisfactorily.  Most fractures of the tibia require the application of a cast or splint for 4 to 6 weeks, and sometimes even longer depending on the severity.
• Closed reduction:  For severe angled fractures in which the bones have not broken through the skin, your doctor will gently manipulate and align the bones properly without the need for surgery. This procedure is called a closed reduction and is performed under local anesthesia to numb the area while the doctor manipulates the bones, so your child is kept comfortable. Once the procedure is complete, a cast is applied to hold the bones in place while they heal.

Surgical methods

Surgical treatment is recommended for complex or open fractures and may involve the use of:

• External fixation: In this procedure, metal pins or screws are placed into the bone below and above the site of the fracture. The screws and pins are secured to a rod outside the skin which holds the bones in the correct position while they heal.
• Intramedullary nailing: During this procedure, a metal rod is placed into the central canal of the tibia passing across the fracture site. Both ends of the intramedullary nail are screwed to the bone to keep the bones and nail in proper position while the fracture heals.
• Plates and screws: In this procedure, the bone fragments are reduced or repositioned into their normal alignment and held together by metal plates and screws fixed to the outer surface of the bone. The plates and screws method is employed when intramedullary nailing is not a viable option.

Recovery post-surgery may take anywhere from 4 to 6 months and varies depending on the severity of the tibial fracture.

Summary

Children are prone to injuries and fractures as they are curious to explore their environment and engage in sports activities. The healing of fractures in children is quicker than that in adults, therefore, it is important to seek immediate medical attention if a fracture is suspected in a child to ensure proper alignment of the bones so that your child can look forward to a normal and active lifestyle.