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Eur J Pediatr Surg 2019; 29(03): 247-252
DOI: 10.1055/s-0038-1632373
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Treatment of Unstable Pediatric Tibia Shaft Fractures in Finland

Antti Stenroos
1   Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
,
Jenni Jalkanen
2   Department of Pediatric Surgery, Kuopion Yliopistollinen Sairaala, Kuopio, Pohjois-Savo, Finland
,
Juha-Jaakko Sinikumpu
3   Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, PEDEGO Research Group and Medical Research Center Oulu, Oulu, Finland
,
Sauli Palmu
4   Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
,
Eeva Koskimies-Virta
5   Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
,
Topi Laaksonen
6   Department of Orthopaedics, Helsingin Yliopisto Lasten ja Nuorten Klinikka, Helsinki, Finland
,
Yrjänä Nietosvaara
7   Department of Orthopaedic Surgery, Helsingin Yliopisto Lasten ja Nuorten Klinikka, Helsinki, Finland
› Author Affiliations Funding None.
Further Information

Publication History

02 November 2017

16 January 2018

Publication Date:
28 February 2018 (online)

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Abstract

Background Surgical treatment of pediatric tibia shaft fractures has gained popularity despite closed reduction and cast-immobilization providing good long-term results. There is no consensus about optimal methods and satisfactory quality of treatment.

Materials and Methods During 2010 to 2014, 226 pediatric patients were treated under anesthesia for tibia shaft fractures in Finland's five university hospitals. A total of 164 (73%) patients had closed fractures of the tibia or both tibia and fibula without other injuries (62 tibia only and 102 both tibia and fibula). Forty-one (18%) had open tibia fractures, 16 had additional fractures, and 5 (2%) had sustained a polytrauma (Injury Severity Score [ISS] > 15). Treatment methods, follow-up protocols, complications, and the outcome were analyzed.

Results A total of 143 (63%) of the tibia fractures were treated surgically: 87 (53%) closed fractures, 36 (88%) open fractures, 15 (94%) with additional fractures, and 5 (2%) polytrauma patients. The rate of surgical treatment of closed tibia fractures was significantly higher in patients older than 10 and in patients with a concomitant fibula fracture. Fasciotomy was done in 33 (15%) patients. Reoperations were performed in 13 (6%) patients because of unsatisfactory treatment (inappropriate primary reduction 6, malunion 6, and non-union 1). There were no differences between the five university hospitals in treatment or follow-up protocols.

Conclusion Internal fixation is used for the majority of tibia shaft fractures treated under anesthesia in university hospitals in Finland. Serious fracture or treatment related complications are very rare, but the percentage (6%) of re-operations because of unsatisfactory standard of treatment should be lower and could probably be improved by concentrating internal fixation to fewer hands. A prospective randomized controlled trial comparing non-operative treatment to intramedullary nailing in pediatric tibia fractures should be performed.

Keywords

trauma - fracture - tibia fracture - conservative treatment
 

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