Study Identifies Comparable Complications in Pediatric Tibia Fractures

For years, many pediatric orthopedic providers have believed that open tibial shaft fractures (ones that go through the skin) lead to more complications in children than closed fractures (ones where the skin stays intact) due to studies in adults showing this finding. Because of this, many have taken more aggressive approaches to treatment, suggesting additional surgeries to ensure positive outcomes.

Researching open and closed tibia fractures

Experts in Children’s Hospital Colorado’s Orthopedics Institute recently conducted a pilot study to explore that assumption and potentially change the way doctors think about fracture care. The team conducted a matched cohort study based on age, sex and injury pattern. Researchers compared 30 pediatric open tibia fractures to 30 matched closed fractures, specifically examining outcomes including infection, nonunion and angular deformities.

They found that complication rates were similar between open and closed tibial fractures. The most common issues across both groups were angular deformity and compartment syndrome, which occurred in 10% of children in each group. While open fractures required more surgical intervention, longer immobilization and more frequent use of external fixation, such as plates and screws, these factors didn’t create higher complication rates.

Follow-up care for tibia fractures

These findings highlight the importance of vigilant monitoring for all pediatric tibia fractures for complications such as compartment syndrome and angular deformity. While open fractures often require more complex management, the study found that outcomes are comparable when specialists provide coordinated care and consistent follow-up.

“Overall, my hope is that this study convinces people to not do multiple surgeries when it’s not necessary,” says orthopedic surgeon Julia Sanders, MD. “The sooner you can get kids out of the hospital and the fewer times you need to operate to heal, the better for the child and for the family.”

In the future, the team plans to integrate patient-reported outcomes into future studies to more accurately capture recovery experiences and better understand comprehensive outcomes. This continued research will help refine treatment strategies and identify which approaches best support bone healing and long-term function.