Classic history and presentation: Pediatric patients with tibial shaft fractures typically present directly after trauma with visible lower leg deformity and inability to bear weight. Toddlers may present with a limp and refusal to bear weight without a distinguishable traumatic mechanism or limb deformity.
- Age – Lower leg fractures are most common in patients aged 10-14 years.
- Sex / gender – Pediatric tibial shaft fractures are more common in boys than girls.
Pathophysiology: The tibia is the primary load-bearing bone of the lower leg. Higher-energy mechanisms result in more complex fracture patterns, higher risk of concurrent fibular injury, and increased degrees of soft tissue damage. Axial loading may cause comminuted fractures. Low-energy rotational or torsional force more often results in spiral fractures.
Grade / classification system: Pediatric tibial shaft fractures have no formal classification system and are typically described based on fracture location (proximal, midshaft, distal) and pattern. Common patterns include incomplete (greenstick fractures), complete (transverse, oblique, etc), and spiral fractures (toddler's fracture).