Percutaneous plating in paediatric tibial fractures

Background: Although non-operative treatment is a mainstay of tibial fracture management in children, certain fractures require a surgical approach. However, choices concerning optimal methods and implants are difficult. The purpose of this study was to determine the effectiveness of percutaneous plating of tibial fractures in children. Materials and methods: Sixteen tibial fractures treated using the percutaneous plating technique between 2000 and 2007 were reviewed. The mean age at operation was 10 years 9 months (range: 6-16 years). There were eight open and closed fractures each. Operative indications were acute fractures with associated injuries or fractures, open fractures and compartment syndrome. Nonunions or failures following other treatments were also indicated. Without exposing the fracture sites, the plates were fixed through a subcutaneous tunnel from remote incisions. Results: All fractures healed without a bone graft. The mean time required for union was 13 weeks (range: 8-24 weeks). No major complications such as malunion, implant failure or deep infection occurred. With the exception of one case with a 15-mm overgrowth, no discrepancy in leg length over 10 mm was encountered. Other minor complications included one case each of transient superficial infection and skin irritation caused by the plate. All patients achieved an excellent or satisfactory clinical outcome with no limping. Summary: Percutaneous plating technique is a safe alternative treatment for paediatric tibial fractures that are difficult to manage using other methods.