Abstract
Aims
Compartment syndrome (CS) is a well-recognised, serious complication of long bone fractures. The association between CS and tibial shaft fractures is well documented in adult patients and in children with open or high velocity trauma. There is, however, little literature on the risk of developing CS in children with closed tibial fractures. In a number of units these children are routinely admitted for elevation and monitoring for CS.
We audited our experience of managing paediatric tibial fractures to ascertain whether it may be safe to discharge a sub-group of these children.
Methods
We audited all children up to the age of 12 years admitted to our hospital over a 5 year period. We reviewed radiographs and clinical notes to determine fracture pattern, modality of treatment, and complications.
Results
We audited 159 tibial fractures. The mean age was 5.8 years (1–12 years), 95 boys, 64 girls. 105 (66%) closed fractures were conservatively managed: 87 of these were diaphyseal and 20 involved both tibia and fibula. Of the conservatively managed fractures, 89 (85%) were minimally displaced (< 5 degrees varus/valgus/anterior angulation, < 5 degrees rotation, < 5mm shortening, no posterior angulation).
In the conservatively managed group there were 3 cases of angulation in cast, managed with wedging. There were no other complications and no cases of compartment syndrome.
Conclusion
Of the 105 closed tibial fractures we managed conservatively, most were minimally displaced, diaphyseal, tibia-only fractures. No patient developed compartment syndrome. Based on our experience we suggest that children with closed, minimally displaced tibial fractures do not require admission for monitoring of CS and may go home in a plaster-slab with early fracture clinic follow-up providing suitable supervision is in place, pain is controlled, and they are able to mobilise safely.
