Skiing injuries in children: lower leg fractures.

Ungerholm S, Gierup J, Lindsjo U, Magnusson A. Int J Sports Med 1985 Oct;6(5):292-7

A study was made of 113 children who sustained a lower leg fracture during downhill skiing. The age distribution showed a peak between 4 and 7 years in both sexes, and boys had another peak in their teens. Three of four patients were beginners. To a large extent, they had had their bindings adjusted in ski shops. Three of four bindings did not release at the time of the accident. Spiral fractures in the shaft or distal metaphysis of the tibia predominated (73%); the incidence of concomitant fibular fracture was low. The degree of malalignment was generally small. The results of treatment, which was generally conservative, were good, 7% of the patients having minor sequelae 1-3 years after the accident. To reduce the risks in children’s downhill skiing, the following measures seem important: intensified training during the beginner stage; increased supervision by parents and in ski schools; development of children’s release bindings and testing methods; and adequate instruction of personnel in ski shops.

Intramedullary Kirschner wiring for tibia fractures in children.

Qidwai SA. J Pediatr Orthop 2001 May-Jun;21(3):294-7

This is a retrospective analysis of the results of 84 tibial fractures in children treated by intramedullary Kirschner wiring. Thirty were open fractures (9 grade I, 10 grade II, 8 grade IIIA, 3 grade IIIB). There were 65 boys and 18 girls with an average age of 10.23 years (range 4-15). The patient was placed supine on an orthopedic traction table. Under fluoroscopic control, two Kirschner wires (2.5-3.5-mm thick) were introduced antegrade from proximal metaphysis (level of tibial tuberosity) to distal metaphysis, one each from medial and lateral cortices. Open fractures were stabilized after meticulous wound debridement. Average time to union was 9.5 weeks (range 8-14). None developed delayed union. However, one grade IIIB open fracture progressed to infected nonunion; it healed after an autogenous bone graft. No infections were seen in closed fractures, but four superficial and one deep infection occurred in open fractures. Closed intramedullary Kirschner wire fixation for unstable or open tibial fractures in children is a simple surgical technique that produces good clinical and functional results.

Isolated fractures of the tibia with intact fibula in children: a review of 95 patients.

Yang JP, Letts RM. J Pediatr Orthop 1997 May-Jun;17(3):347-51

Isolated tibial fractures with an intact fibula are the most common tibial fracture pattern in children. When displaced, this fracture can be difficult to reduce and retain in the position because of the splinting of the intact fibula. A 4-year review of 95 children with fracture of the tibia with an intact fibula was performed at the Children’s Hospital of Eastern Ontario. Eighty-one percent of the fractures were caused by an indirect rotational twisting force. Seventy-three percent of fractures were localized at the distal third of the tibial shaft. Varus angulation deformity occurred most commonly when the fracture line started distally on the anteromedial side of the tibia and progressed in an oblique or spiral manner to the proximal posterolateral aspect of the tibia. This was postulated to be caused by the posterior flexor muscle forces being more concentrated medially, whereas laterally, the intact fibula acts like a splint, thus producing a bending moment resulting in varus angulation. Close follow-up and monitoring of the isolated tibial fractures with weekly radiographs for the first 3 weeks is recommended.