Short Leg Cast Versus Long Leg Cast Immobilization for Pediatric Tibia Fractures: A Systematic Review and Meta-Analysis

BACKGROUND: Pediatric tibial fractures are common long-bone injuries, yet uncertainty remains in the optimal immobilization strategy. The comparative effectiveness and safety of short leg versus long leg casts in achieving stable healing and functional recovery have not been clearly established. METHODS: A literature search was conducted across Medline, CINAHL, Embase, and Cochrane Library, from inception to August 2025, following PRISMA guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO). Statistical analyses were performed using a random-effects model. RESULTS: The initial search yielded 1236 studies; 6 studies with 413 pediatric patients met the inclusion criteria. A total of 163 underwent short leg casting (SLC) and 250 long leg casting (LLC). No differences were observed between SLC and LLC for coronal angulation (MD=0.12 degrees, 95% CI=-0.89 to 1.12, I2=58%) or sagittal angulation (MD=0.18 degrees, 95% CI=-0.71 to 1.07, I2=56%). Subgroup analyses showed no differences for tibial shaft fractures or Salter-Harris distal tibial fractures. Cast duration was similar between groups (MD=-0.74 wk, 95% CI=-1.49 to 0.01, I2=92%). Overall complication rates did not differ (OR=0.76, 95% CI=0.25 to 2.34, I2=0%), with no differences in Salter-Harris subgroup analysis (OR=0.67, 95% CI=0.05 to 9.91; I2=54%). SLC was associated with shorter time to weight-bearing (MD=-2.29, 95% CI=-4.49 to -0.08, I2=68%) and faster time to union (MD=-1.21, 95% CI=-2.16 to -0.25, I2=30%). CONCLUSION: SLCs may be considered as an alternative to LLCs in pediatric tibial shaft and distal tibial physeal fractures based on currently available retrospective comparative evidence. However, the evidence is limited by the retrospective design, clinical heterogeneity, and risk of confounding. Further prospective comparative studies are needed to define optimal indications for SLC use in this population. LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis of retrospective comparative studies.