Tibial Shaft Fracture Treated with a Circular External Fixator

Abstract

Tibial shaft fractures in children and adolescents require special consideration when determining the most appropriate treatment due to the presence of open, growing physes. While antegrade, reamed, locked intramedullary nailing remains the most common treatment for similar adult injuries, it is not commonly performed in growing children due to the requirement of a relatively large entry site through the proximal tibial physis, risking physeal arrest. Goals of surgical treatment for tibial shaft fractures in children and adolescents include restoration of normal limb alignment and length, without risking further damage to the growing physis. Options to treat tibial shaft fractures in these age groups typically include closed manipulation and casting, flexible intramedullary nails, and external fixation. This chapter discusses the relative benefits of external fixation, the author’s preferred fixation technique, and typical postoperative protocols.

A 12-year-old boy presented after falling on a trampoline and sustaining an injury with obvious pain and deformity of the right lower leg. Radiographs in the emergency department revealed a displaced fracture of the right tibial shaft, with an associated fracture of the proximal fibular shaft. Attempted closed manipulation was performed under sedation, but the fracture remained displaced, shortened, and slightly angulated. After a discussion of options with the family, the patient was given a general anesthetic; a circular external fixator was applied to the proximal and distal tibial shaft, spanning the tibial fracture site; and the fracture was reduced. No other supplemental immobilization was required. The patient was allowed to bear weight as tolerated, perform range of motion exercises of the knee and ankle as tolerated, and perform daily, routine pin site care. The patient healed the tibial fracture well, and the external fixator was removed under a second general anesthetic about 10 weeks later.