{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T12:54:21Z","timestamp":1768308861607,"version":"3.49.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Because adolescent distal third tibia fractures pose treatment challenges, we aimed to identify factors predictive of failure among common treatment methods: casting without manipulation, closed reduction and casting (CRC) and open treatment. Among displaced fractures, we compared outcomes between CRC versus open treatment. Skeletally immature individuals (10\u201317 years) with extra-articular distal third tibia fractures at a level 1 trauma center (2011\u20132017) were retrospectively reviewed. Patient demographics, injury and treatment characteristics and complications were recorded. Radiographs were evaluated for unacceptable alignment (angulation &gt;5\u00b0, translation &gt;50%, and shortening &gt;1 cm) and time to union. Of 140 individuals, casting was the most common treatment method (<jats:italic toggle=\"yes\">n<\/jats:italic> = 81), followed by CRC under anesthesia\/sedation (<jats:italic toggle=\"yes\">n<\/jats:italic> = 38), and open treatment (<jats:italic toggle=\"yes\">n<\/jats:italic> = 34). For fractures casted without manipulation, increased fracture severity based upon our novel grading system [hazard ratio (HR): 10.5, 95% CI, 4.2\u201327.5, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.0001] was significantly related to treatment failure. Outcomes for a selected group of 47 initially displaced fractures (33 CRC and 14 open treatments) were evaluated. For CRC, 9 (27.3%) healed with malunion and 6 (18.2%) failed initial CRC, resulting in a treatment failure rate of 36.7%. For open treatment, 2 (14.3%) underwent hardware removal, 2 (14.3%) healed with malunion and one developed infection requiring reoperation. No fractures healed with malunion required surgical correction during the study period. The odds of persistent malalignment in CRC was 3.77 [95% CI, 0.44\u201332.60, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.2274] times open treatment. Adolescent minimally displaced distal tibial fractures can undergo successful treatment with casting. However, displaced fractures have a higher chance of short-term failure with CRC. Close monitoring of displaced fractures in the adolescent is essential during conservative management.<\/jats:p>","DOI":"10.1097\/bpb.0000000000000896","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T02:00:52Z","timestamp":1626832852000},"page":"e147-e153","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Outcomes of displaced adolescent distal third tibia fractures: can we do better?"],"prefix":"10.1097","volume":"31","author":[{"given":"Wendy G.","family":"Ramalingam","sequence":"first","affiliation":[{"name":"Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Carry","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Musculoskeletal Research Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Brazell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Musculoskeletal Research Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Calkins","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Musculoskeletal Research Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Linza-Moscati","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Musculoskeletal Research Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Stoneback","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Colorado, Denver"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy Hadley","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"key":"R1-20250526","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.injury.2010.02.019","article-title":"Distal metadiaphyseal tibial fractures.","volume":"42","author":"Newman","year":"2011","journal-title":"Injury"},{"key":"R2-20250526","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.ocl.2014.04.001","article-title":"Techniques for the surgical treatment of distal tibia fractures.","volume":"45","author":"Richard","year":"2014","journal-title":"Orthop Clin North Am"},{"key":"R3-20250526","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jor.2013.12.002","article-title":"Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures.","volume":"11","author":"Yaligod","year":"2014","journal-title":"J Orthop"},{"key":"R4-20250526","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/S0030-5898(20)31922-2","article-title":"Biomechanics of malalignment.","volume":"25","author":"Chao","year":"1994","journal-title":"Orthop Clin North Am"},{"key":"R5-20250526","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/BOT.0b013e31823924df","article-title":"Factors influencing functional outcomes after distal tibia shaft fractures.","volume":"26","author":"Vallier","year":"2012","journal-title":"J Orthop Trauma"},{"key":"R6-20250526","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/01.blo.0000137550.68318.f8","article-title":"450 closed fractures of the distal third of the tibia treated with a functional brace.","volume":"428","author":"Sarmiento","year":"2004","journal-title":"Clin Orthop Relat Res"},{"key":"R7-20250526","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/BOT.0000000000000631","article-title":"Suprapatellar intramedullary nail technique lowers rate of malalignment of distal tibia fractures.","volume":"30","author":"Avilucea","year":"2016","journal-title":"J Orthop Trauma"},{"key":"R8-20250526","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1097\/00005373-198411000-00007","article-title":"Infra-isthmal longitudinal fractures of the tibial diaphysis: results of treatment using closed intramedullary compression nailing.","volume":"24","author":"B\u00f6stman","year":"1984","journal-title":"J Trauma"},{"key":"R9-20250526","doi-asserted-by":"crossref","first-page":"675","DOI":"10.5435\/00124635-201211000-00001","article-title":"Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation.","volume":"20","author":"Casstevens","year":"2012","journal-title":"J Am Acad Orthop Surg"},{"key":"R10-20250526","first-page":"Cd010261","article-title":"Surgical interventions for treating distal tibial metaphyseal fractures in adults.","volume":"3","author":"Kuo","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"R11-20250526","doi-asserted-by":"crossref","first-page":"e407","DOI":"10.1097\/BOT.0000000000000989","article-title":"Proper distal placement of tibial nail improves rate of malalignment for distal tibia fractures.","volume":"31","author":"Triantafillou","year":"2017","journal-title":"J Orthop Trauma"},{"key":"R12-20250526","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1097\/BOT.0b013e318213f709","article-title":"Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures.","volume":"25","author":"Vallier","year":"2011","journal-title":"J Orthop Trauma"},{"key":"R13-20250526","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/01.bot.0000202997.45274.a1","article-title":"Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures.","volume":"20","author":"Zelle","year":"2006","journal-title":"J Orthop Trauma"},{"issue":"Suppl 1","key":"R14-20250526","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1097\/BPO.0000000000000762","article-title":"Tibia shaft fractures in adolescents: how and when can they be managed successfully with cast treatment?","volume":"36","author":"Ho","year":"2016","journal-title":"J Pediatr Orthop"},{"key":"R15-20250526","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1097\/BPO.0000000000000532","article-title":"Operative versus conservative management of displaced tibial shaft fracture in adolescents.","volume":"36","author":"Kinney","year":"2016","journal-title":"J Pediatr Orthop"},{"key":"R17-20250526","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/BPB.0000000000000144","article-title":"Tibial shaft fractures in adolescents: analysis of cast treatment successes and failures.","volume":"24","author":"Ho","year":"2015","journal-title":"J Pediatr Orthop B"},{"key":"R18-20250526","first-page":"259","article-title":"Crural fractures in children. A study of the incidence of changes of the axial position and of enhanced longitudinal growth of the tibia after the healing of crural fractures.","volume":"23","author":"Swaan","year":"1971","journal-title":"Arch Chir Neerl"},{"key":"R20-20250526","first-page":"633","article-title":"[Bone development after abnormal healing of lower leg shaft fractures in children].","volume":"91","author":"Bennek","year":"1966","journal-title":"Zentralbl Chir"},{"key":"R21-20250526","doi-asserted-by":"crossref","first-page":"448","DOI":"10.3109\/17453677608988718","article-title":"Fractures of the tibia in children.","volume":"47","author":"Hansen","year":"1976","journal-title":"Acta Orthop Scand"}],"container-title":["Journal of Pediatric Orthopaedics B"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BPB.0000000000000896","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T22:06:07Z","timestamp":1748297167000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BPB.0000000000000896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,19]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1097\/bpb.0000000000000896","relation":{},"ISSN":["1060-152X"],"issn-type":[{"value":"1060-152X","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7,19]]}}}