LONG-TERM TRENDS AND OUTCOMES IN PAEDIATRIC DIAPHYSEAL TIBIAL FRACTURE MANAGEMENT: A 20-YEAR SINGLE-CENTRE REVIEW

Introduction Paediatric tibial fractures are common, yet management strategies vary across age groups. This study reviews 20 years of experience at a major trauma centre (UHW) to evaluate management trends and clinical outcomes, specifically focusing on radiological outcomes and reported complications. Methods A retrospective review was conducted on 338 patients aged 3 to 15.9 years admitted with diaphyseal tibial fractures between 2005 and 2025. Outcomes were investigated by age: Toddlers (3–4), Children (5–12), and Adolescents (13–15). Deformity was defined as >5° in the coronal plane and >10° in the sagittal plane. Results Distal third fractures were the most frequent (58%), followed by middle (39%) and proximal (4%). Open fractures were rare (4%). Management shifted with age: 80% of toddlers were successfully managed conservatively, with only 3% of those patients failing conservative management. Conversely, 57% of adolescents required definitive surgical intervention, with ORIF being the most common definitive procedure (51%). External fixation was next most common (18%) followed by MUA with Above knee casting (16%). Residual angular malunion of the tibia was commonly seen at follow up. Varus deformity was more prevalent in conservatively managed patients (36%) compared to surgical intervention (18%). Recurvatum was the most common sagittal deformity. Furthermore, 40% of patients with an intact fibula developed a varus deformity. Conclusion While conservative management remains the gold standard for younger paediatric patients, adolescents frequently require surgical intervention. The high incidence of varus deformity suggests that close monitoring or lower thresholds for intervention may be required, especially in the adolescent population.