Residual Deformity and Outcome in Non-Surgically Treated Tibial Shaft Fractures in Adolescents Nearing Skeletal Maturity

Abstract

Background. Anatomic reduction is crucial to avoid malalignment in tibial shaft fractures in adolescents approaching physeal closure. While surgical treatment is becoming more common, casting and immobilization are still widely done for appropriately selected fractures. Local radiographic and clinical outcomes of non-surgical treatment need to be explored. Objective. The primary objective of this study was to report residual lower limb deformity of tibial shaft fractures treated non-surgically in adolescents nearing skeletal maturity. The study also identified factors or fracture characteristics that may predict these deformities and reported the clinical outcomes using the Lower Extremity Functional Scale (LEFS). Methodology. This was a cross-sectional study of 31 adolescents nearing skeletal maturity at the time of injury with acute closed tibial shaft fractures treated non-surgically at the Philippine Orthopedic Center from 2017 to 2020. Skeletal maturity and residual sagittal & coronal angulation were analyzed through radiographs. Rotational alignment and leg length discrepancies were evaluated clinically. Functional outcome was measured using the LEFS. Results. Coronal plane angulation (r = -0.397; p = 0.05) and leg length discrepancy (r = -0.394; p = 0.05) were inversely correlated with LEFS scores. Coronal plane angulation was also correlated with ipsilateral fibular fractures (p = 0.007). LEFS scores were 79.39 on average (range 75 to 80). Conclusion. Among adolescents nearing skeletal maturity with isolated acute tibial shaft fractures, closed reduction and casting followed by close monitoring remains useful and effective.

Keywords

• tibial shaft fracture
• adolescent
• angulation
• rotational deformity
• malrotation
• Lower Extremity Functional Scale (LEFS)