Remodeling of Pediatric Tibial Shaft Fractures: What Should We Expect?

Background: While the majority of tibial shaft fractures in pediatric patients are managed nonoperatively with closed reduction and casting, it is unknown how much remodeling occurs in young patients. We hypothesize that younger children would exhibit greater remodeling and lower residual angulation compared to older children six months post-injury. Methods: Patients under age 17 years at a major pediatric health system with ICD-9 or ICD-10 codes for closed tibial shaft fractures between January 2009 and August 2023 were included. Patients with radiographs at baseline and six-month follow-up were eligible. Exclusion criteria were operative management, open, or comminuted fractures; refractures; history of malignancy or metabolic diseases; or lack of imaging. Radiographs post-reduction and at six months were reviewed to assess translation, angulation, shortening, and remodeling in the coronal and sagittal planes. Differences in baseline and follow-up measurements were compared between children under age 8 and aged 8-16 years. Results: Thirty-eight patients (14 female) were included with an average age of 7.3 years (Range 1 year to 14 years). Baseline translation for younger patients was 13.5% ± 18.1% and 15.1% ± 13.7% in the coronal and sagittal plane, respectively; baseline translation for the older cohort was 20.9% ± 13.5 and 24.1 ± 17.3% for the coronal and sagittal plane, respectively. All patients demonstrated complete correction of fracture translation in both planes at six months post-injury ( Conclusions: Tibial shaft fracture translation resolves over six months for all pediatric patients. Younger children tend to have less residual angulation and more remodeling, particularly in the sagittal plane. Our findings suggest that more attention is needed to minimize coronal angulation following tibial shaft fractures in pediatric patients. Key Concepts: (1)Pediatric tibial shaft fractures demonstrate substantial remodeling capacity, with all study patients showing complete correction of fracture translation and shortening within six months of nonoperative treatment.(2)Nonoperative management remains an effective and reliable treatment strategy for appropriately selected pediatric tibial shaft fractures.(3)Younger children exhibit significantly greater remodeling potential, particularly in the sagittal plane, resulting in lower residual angulation compared to older children.(4)Age-related differences in remodeling support individualized treatment approaches. Level of Evidence: Level III, retrospective cohort study.