Pediatric Tibial Shaft Fractures: Management and Outcomes. Experience of Mohammed VI University Hospital, Tangier, Morocco
M. Chami *
Department of Pediatric Surgery, Faculty of Medicine and Pharmacy of Tangier, Mohammed VI University Hospital, Abdelmalek Essaâdi University, Tangier, Morocco.
A. Boutahar
Department of Pediatric Surgery, Faculty of Medicine and Pharmacy of Tangier, Mohammed VI University Hospital, Abdelmalek Essaâdi University, Tangier, Morocco.
T. Bentayeb
Department of Pediatric Surgery, Faculty of Medicine and Pharmacy of Tangier, Mohammed VI University Hospital, Abdelmalek Essaâdi University, Tangier, Morocco.
H. Aboueljaoud
Department of Pediatric Surgery, Faculty of Medicine and Pharmacy of Tangier, Mohammed VI University Hospital, Abdelmalek Essaâdi University, Tangier, Morocco.
L. Chater
Department of Pediatric Surgery, Faculty of Medicine and Pharmacy of Tangier, Mohammed VI University Hospital, Abdelmalek Essaâdi University, Tangier, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Tibial shaft fractures in children are generally managed non-operatively, although elastic stable intramedullary nailing (ESIN) is increasingly used.
Aim: This study describes management and outcomes at Mohammed VI University Hospital in Tangier, Morocco.
Methods: A retrospective descriptive assessment was conducted among 22 children treated for tibial shaft fractures. Demographic characteristics, injury mechanisms, fracture patterns, treatment pathways, healing, complications and clinical outcomes were reviewed using medical records and radiographs.
Results: The mean age was 10.4 years, and 77.3% of patients were boys. Road traffic accidents accounted for 59.1% of injuries, and 18.2% of fractures were open. Closed reduction and casting were used initially in 63.6% of children. Secondary displacement occurred in 21.4% of those initially treated with casting, requiring conversion to ESIN. Overall, ESIN was used in 40.9% of patients and external fixation in 9.1%. Fracture union occurred in all patients, with a mean time to union of eight weeks. Compartment syndrome occurred in 9.1% and was treated with emergency fasciotomy. At a mean follow-up of 11 months, no infection, non-union, malunion or lower-limb length discrepancy was recorded. Excellent outcomes were reported in 63.6% overall and in 88.9% of patients treated with ESIN.
Conclusions: Casting remained a treatment option for stable fractures, while ESIN was used for unstable fractures or after loss of reduction. These descriptive findings should be interpreted cautiously because of the small cohort.
Keywords: Tibial fracture, child, elastic stable intramedullary nailing, casting, compartment syndrome