Tibia Fracture Research Paper

INTRODUCTION
Shaft of tibia fractures are the third most common paediatric long bone fractures (15 %) after forearm and Femur fractures. 1,2,3
The prevalence of paediatric tibia fractures is on a rise since 1950. 4 Average age of presentation is 8 years. Bicycle spoke injury causing tibia fractures occur almost exclusively in children 1-4 years of age . Most tibial fractures in children 4-14 years of age are a result of road traffic accidents or while playing.
Ipsilateral Fibula fractures are associated in 30 % of cases. 2,3,5,6
Tibia is the second most commonly fractured bone in child abuse. 3,7 Torsional force causes tibia fractures most commonly under 11 years of age .3,8
Varus angulation is more common in isolated fractures of tibia while

. Overgrowth is not routinely seen in girls older than 8 years or boys older than 10 years.1,9
There is a little disagreement concerning the treatment of long bone fractures in children less than 5 years (POP cast) and adolescents older than 14 years (locked intramedullary nailing).13 Controversy persists regarding the age between 5 to 14 years, with several available options: external fixation, flexible stable intramedullary nails, plate fixation, and locked intramedullary nailing.
Intramedullary nailing for treatment of fracture shaft of tibia is well known in children. It is usually done for fixation of transverse or short oblique fractures involving middle or distal one third. It is a load sharing device and as such if used properly, it allows rapid rehabilitation of patients and much earlier weight bearing than another method. It leads to rapid healing with low incidence of malunion. Dynamic compression plating is another alternative that has been recommended for the treatment of tibial shaft fractures specially for comminuted fractures, fractures associated with neurovascular

However their use in closed tibial shaft fractures is not palatable to all. Moreover it leads to knee stiffness and increased incidence of refractures. The goals of any method of treatment should be to stabilise the fracture, to control length and alignment, to promote bone healing, and to minimise the morbidity and complications for the child and his/her family. Orthopaedic surgeons will continue to be challenged to treat this age group with less morbidity at a lower cost, as no clear guidelines have been available until now despite efforts done initially by French surgeons, later on by European surgeons and recently by the Paediatric Orthopaedic Society of North America (POSNA).14
Operative management in fracture tibia in pediatric age group has generated increased interest and has been a matter of debate since last 3 decades
Generally accepted indications15,16,17 for surgical treatment were:-
1. Inability to obtain or maintain a satisfactory reduction(unstable fracture)
2. Open tibial fracture
3. Polytrauma patients with multiple long bone/multiple system injuries
4. Head injury with spasticity/cerebral