Highlights of Pediatric distal tibial and fibular fractures

The content of the pediatric distal tibial and fibular fracture management has been authored by Daniel Green (US), Philip Henman (UK), and Mamoun Kremli (SA) with Fergal Monsell (UK) and James Hunter (UK) as editors.

Visit the module entry page here!

This module covers the treatment options for:

• Metaphyseal fractures of the distal tibia and fibula
• Epiphyseal fractures of the distal tibia and fibula
• Injuries to the syndesmosis

Besides the Salter-Harris fractures, it describes in detail the Tillaux and triplane fractures and their management.

The section on triplane fractures contains a logical approach to fixation. It is accompanied by a description page with very clear illustrations of the fracture pattern in three dimensions.

Before attending a pediatric fracture course, it is recommended to read about Salter-Harris III and IV, and triplane fractures, as these frequently cause difficulty to delegates.

The pediatric material of the distal tibia and fibula, first edition, includes a detailed description of the following fracture types and their management.

Metaphyseal tibia

Torus/buckle fracture:

• Short leg cast

Simple complete fracture:

• Short leg cast
• Closed reduction; short leg cast
• Closed reduction; K-wire fixation
• External fixation
• Elastic nailing
• MIO bridge plating

Multifragmentary complete fracture:

• Long leg cast
• Closed reduction; long leg cast
• Closed reduction; K-wire fixation
• External fixation
• Elastic nailing
• MIO bridge plating
• Open reduction; plate fixation

Metaphyseal fibula

Torus/buckle fracture:

• Short leg cast

Complete fractures:

• Short leg cast
• Closed reduction; short leg cast
• Open reduction; plate fixation

Epiphyseal tibia

Epiphysiolysis (Salter-Harris I):

• Short leg cast
• Closed reduction; short leg cast
• Closed reduction; K-wire fixation
• External fixation
• Open reduction; K-wire fixation

Epiphysiolysis with metaphyseal wedge (Salter-Harris II):

• Short leg cast
• Long leg cast
• Closed reduction; short leg cast
• Closed reduction; long leg cast
• Closed reduction; K-wire fixation
• External fixation
• Closed reduction; screw fixation
• Open reduction; K-wire fixation
• Open reduction; screw fixation

Epiphyseal fractures (Salter-Harris III):

• Long leg cast
• External fixation
• Open reduction; K-wire fixation
• Open reduction; screw fixation

Epi-/metaphyseal fractures (Salter-Harris IV):

• Long leg cast
• External fixation
• Open reduction; K-wire fixation
• Open reduction; screw fixation
• Open reduction; plate fixation

Anterolateral epiphyseal fractures (Tillaux fractures):

• Long leg cast
• Open reduction; screw fixation

Complex epi-/metaphyseal fractures (triplane fractures):

• Long leg cast
• External fixation
• Open reduction; screw fixation

Avulsion fractures of the medial malleolus:

• Short leg cast
• External fixation
• Open reduction; screw fixation

Osteochondral fractures (intraarticular flake):

• Short leg cast
• Open reduction; pin or screw fixation
• Excision

Epiphyseal fibula

Epiphysiolysis (Salter-Harris I and II):

• Short leg cast
• Closed reduction; short leg cast
• Closed reduction; K-wire fixation
• Closed reduction; screw fixation
• Open reduction; K-wire fixation
• Open reduction; screw fixation
• Open reduction; plate fixation

Malleolar/ligament injuries

Syndesmotic injuries:

• Short leg cast
• Stabilization with screws
• Stabilization with suture and button (suspensory fixation)

The following additional material is available for this module.

Approaches:

• Anteromedial approach to the pediatric distal tibia
• Anterolateral approach to the pediatric distal tibia
• Lateral approach to the pediatric distal fibula
• Posterolateral approach to the pediatric distal tibia
• Minimally invasive approach to the pediatric distal tibia
• Entry points for antegrade elastic nailing in the distal tibia
• Safe zones for pin placement in the tibia and foot

Patient preparations:

• Supine position
• Lateral decubitus position

Further reading:

• Clinical evaluation
• Radiological evaluation
• Comlications and technical failures