Overlooked valgus bowing deformity in pediatric tibial shaft fractures with/without fibular involvement: Cause residual valgus alignment in 2-year follow-up - 01/04/23

Doi : 10.1016/j.otsr.2023.103610

Kunhyung Bae ^a,^b, Jinseok Yang ^a, Michael Seungcheol Kang ^a,⁎
^a Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, 88, Olympic-ro, 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
^b Department of Orthopedic Surgery, Hanyang University College of Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdong-gu, 04763 Seoul, Republic of Korea

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 01 April 2023

Highlights

•	Pediatric tibial shaft fracture has a risk of valgus bowing deformity, and accompanying fibular fracture is the associated risk factor.
•	This bowing deformity might remain until 2-year follow-up.

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Abstract

Background

Children with a tibial shaft fracture often present with valgus malalignment, even when anatomical reduction had been achieved at the fracture site. Pediatric bony structure has more elastic bones than that of adults, it can cause bowing deformity. Therefore, we evaluated pediatric tibial shaft fracture for the presence of bowing deformity, associated risk factors, and its clinical significance.

Hypothesis

There is an overlooked bowing deformity in pediatric tibial shaft fracture.

Patients and methods

Fifty-seven tibial shaft fracture patients aged 2 to 15 years with Risser stage 0 were retrospectively reviewed. Clinicoradiologic factors and radiographs taken within 3 post-traumatic months and at 2 years were assessed. To evaluate the tibial bowing deformity, the tibial interphyseal angle and tibial shaft angle were measured, and their differences were calculated as a tibial bowing angle.

Results

Multivariate analysis revealed the tibial shaft fracture with fibular involvement is significantly associated with a higher initial tibial bowing angle (valgus deformity). The tibial bowing angle did not change over 2-year follow-up. A high initial tibial bowing angle (≥ 5°) was a significant risk factor for the persistence of valgus malalignment.

Discussion

Pediatric tibial shaft fractures with/without fibular involvement carry the risk of valgus bowing deformity, which may not develop during post-traumatic growth but may be present at the time of injury. The risk is high if the tibial fracture is accompanied by a fibular fracture. This tibial deformity presents limited remodeling potential at 2-year follow-up.