Do minimally displaced, closed tibial fractures in children need monitoring for compartment syndrome?

Abstract

Acute compartment syndrome (ACS) may be seen following tibial fractures in adults. Although the risk of this complication is thought to be lower in children (especially in those under the age of 12 years) it is routine practice in many units to admit all children with this injury for observation. The aim of this study was to ascertain whether all children under the age of 12 presenting with fractures of the tibia merited admission and to provide recommendations on how to manage these patients based on our experience with this injury. We retrospectively studied the clinical and radiographic progress of consecutive patients presenting to our institution with tibial fractures over a 5-year period. A total of 159 tibial fractures were seen in the study period. The mean age of patients treated was 5.8 years. 81% of the injuries occurred in the diaphyseal region and 60% involved the tibia only. A total of 9% of injuries were open and overall 66% of fractures were managed non-operatively. No cases of ACS were seen. Based on our experience we provide a treatment algorithm detailing how children in the under 12 age group presenting with tibial fractures may be managed. Patients with minimally displaced fractures involving the tibia only, whose pain is adequately controlled and who can safely mobilise with suitable parental supervision may be safely discharged from the emergency department in a back slab with early follow up. Although no children under the age of 12 in the present study developed ACS following a fracture of the tibia, certain features such as a history of a high energy injury, displaced fractures or co-existing fibular fractures should raise suspicion that this complication may ensue. In these cases admission and observation may be warranted.