![]() ![]() ![]() Very rarely, osteotomy of the tibia may be needed to restore alignment. If the deformity does not resolve with growth, these fractures happen in a young enough age group that guided growth is an option for correcting valgus before skeletal maturity. Luckily, this usually resolves without intervention, but the broken leg may appear more knock-kneed for a year or two, which can be quite upsetting to the parents. It may be a combination of these two factors, but it is important to remember (and warn the parents) that Cozen fractures are known for late valgus deformity. When the cast is removed, the child holds the leg flexed making it difficult to see hip to ankle alignment, so it is difficult to know if the leg is in valgus to start and/or if the leg subsequently grows into valgus ( Fig. Diagnosis is clinical and radiological, which can be difficult in a young child or with minimal clinical findings. They require appropriate diagnosis and treatment to minimize complications and optimize outcomes. This is a spiral type fracture of the tibial shaft (in this case visible in both the AP and. Tibial shaft fractures are one of the most common pediatric fractures. The x-ray angulation is typically unimpressive, and most of these fractures are accepted and are casted in situ following the adage that children’s fractures, particularly in younger children, can be expected to remodel and do not require exact angular correction. The x-ray demonstrates what is known as a toddler fracture. Buckle fractures are caused by compressive loading. A valgus-directed force causes the medial cortex of the proximal tibia to open slightly. This image shows a buckle fracture of the tibial metaphysis. It occurs after low-energy trauma, sometimes with a rotational component. The fracture is found in the distal two thirds of the tibia in 95 of cases, is undisplaced and has a spiral pattern. ![]() Traditionally, most tibial fractures in children have been treated non-operatively, but there are no long-term results. Metaphyseal greenstick fractures in children between the ages of 3 and 10 years are known as Cozen fractures. May be associated with proximal tibial buckle fracture (manage both bone fractures as detailed here) All tibial metaphyseal buckle fractures need virtual fracture clinic follow up due to risk of Cozen phenomenon - valgus angulation deformity of the tibia following a proximal tibial metaphyseal fracture. Toddlers fractures are bone fractures of the distal (lower) part of the shin bone in toddlers (aged 9 months-3 years) and other young children (less than 8 years). Background: Tibial fracture is the third most common long-bone fracture in children. ![]()
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