{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T23:50:46Z","timestamp":1781913046734,"version":"3.54.5"},"reference-count":56,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fractures of the diaphysis of the lower leg account for approximately 6% of all fractures in children and adolescents. A distinction must be made between isolated tibial shaft fractures, which are primarily managed conservatively, and combined lower leg shaft fractures (involving both the tibia and fibula). The latter are significantly less stable and therefore more frequently treated with osteosynthesis. If the fracture is non-displaced or tolerably displaced, immobilization in a long leg cast for about 4 weeks is sufficient. This requires that no secondary displacement occurs within the cast, which is why at least one follow-up X-ray after about 7\u201310 days is mandatory. In cases of instability, non-tolerable displacement, open fractures, or (impending) compartment syndrome, surgical treatment is indicated. The elastic stable intramedullary nailing (ESIN) technique is the standard procedure in these cases due to its low risk profile, broad applicability, minimally invasive\n      approach, and good functional outcomes. After ESIN osteosynthesis, immobilization in a cast is not necessary. Other osteosynthesis methods, such as external fixation or plate osteosynthesis, are reserved for special cases like grade III open fractures, refractures, or comminuted fractures. The prognosis for tibial and lower leg shaft fractures in children is very good when conservative or surgical therapy is carried out correctly. Complications such as compartment syndrome, pseudarthrosis, or clinically relevant leg length discrepancies are rare. It is important to be familiar with the age-dependent tolerance limits for remodeling of the lower leg shaft, so that in the event of failure of conservative therapy, the indication for surgical treatment can be made in a timely manner and permanent malalignment of the lower leg with resulting abnormal loading of the knee and ankle joints can be avoided. An important and common special form is the so-called toddler\u2019s fracture, which\n      occurs exclusively in early childhood. This involves a subtle, non-displaced spiral fracture or fissure of the tibial shaft, typically caused by a minor fall, often with a rotational component. These fractures can be easily missed on initial X-ray diagnostics. Immobilization for pain relief is sufficient, and follow-up radiological examinations are generally not necessary.<\/jats:p>","DOI":"10.1055\/a-2762-1851","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:33:21Z","timestamp":1772152401000},"page":"244-251","source":"Crossref","is-referenced-by-count":0,"title":["Updated German National S1 Guideline on Pediatric Lower Leg Shaft Fractures"],"prefix":"10.1055","volume":"164","author":[{"given":"Philipp","family":"Schwerk","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Dresden, Deutschland","place":["Dresden"],"department":["Klinik und Poliklinik f\u00fcr Kinderchirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4938-3300","authenticated-orcid":false,"given":"Christoph","family":"von Schrottenberg","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Dresden, Deutschland","place":["Dresden"],"department":["Klinik und Poliklinik f\u00fcr Kinderchirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurek","family":"Schultz","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Dresden, Deutschland","place":["Dresden"],"department":["Klinik und Poliklinik f\u00fcr Kinderchirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Fitze","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Dresden, Deutschland","place":["Dresden"],"department":["Klinik und Poliklinik f\u00fcr Kinderchirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3109\/17453671003628780","article-title":"Epidemiology of fractures in children and adolescents: Increased incidence over the past decade: a population-based 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