{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T07:57:23Z","timestamp":1785571043307,"version":"3.56.0"},"reference-count":10,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Children's Orthopaedics"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pediatric horizontal distal metaphyseal tibial fractures are relatively uncommon injuries. While nonoperative treatment remains the standard of care for most cases, certain fracture patterns may carry a higher risk of treatment failure, and optimal treatment strategies are still unclear. The aim of this study was to investigate the frequency, anatomical location of these fractures within the metaphysis, and risk factors associated with treatment failure in nonoperative management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective, registry-based cohort study was conducted to evaluate treatment success in 86 consecutive pediatric patients with distal metaphyseal horizontal tibial fractures between 2014 and 2023. Demographic, clinical, and radiographic data were analyzed. Logistic regression analysis was performed to identify independent predictors of nonoperative treatment failure. Nonoperative treatment failure was defined as the requirement for cast wedging, re-reduction, or surgical intervention due to loss of reduction or coronal angulation greater than 10\u00b0 observed on final follow-up radiographs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 86 patients included, 70 (81%) were initially treated non-operatively, while 16 (19%) underwent primary surgical fixation. The overall failure rate in the nonoperative group was 35.3% (25\/70). Multivariable logistic regression identified 3 independent predictors of treatment failure: age &gt;11 years (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 1.3\u201381.7;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.030), the presence of a complete fibular fracture (adjusted OR, 6.1; 95% CI, 1.2\u201330.1;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.027), and initial coronal angulation &gt;10\u00b0 (adjusted OR, 4.9; 95% CI, 1.1\u201323.0;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.042). The complication rate was significantly higher in the operative group compared to the nonoperative group (18.3% vs. 4.3%; relative risk, 4.4; 95%CI 1.0\u201319.7,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Nonoperative treatment remains an effective approach for the majority of pediatric horizontal distal metaphyseal tibial fractures. However, patients with older age, concomitant complete fibular fractures, or marked initial angulation may benefit from early surgical intervention to mitigate the risk of treatment failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:bold>IV<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18632521261436703","type":"journal-article","created":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T14:58:42Z","timestamp":1776005922000},"page":"402-410","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distal metaphyseal horizontal tibial fractures in children"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4665-7477","authenticated-orcid":false,"given":"Halil","family":"Kara","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maija","family":"J\u00e4\u00e4skel\u00e4","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Topi","family":"Laaksonen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, New Children\u2019s Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-8270","authenticated-orcid":false,"given":"Petra","family":"Grahn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, New Children\u2019s Hospital, Helsinki, Finland"},{"name":"University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilkka","family":"Helenius","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsingin Yliopisto Laaketieteellinen tiedekunta, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti Mikael","family":"Ahonen","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital, Helsingin ja Uudenmaan sairaanhoitopiiri, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/18632521241242251"},{"issue":"3","key":"e_1_3_2_3_2","first-page":"59","article-title":"Distal tibial metaphyseal fractures in children treated by intrafocal pinning: a case report","volume":"5","author":"Ghannam MK","year":"2021","unstructured":"Ghannam MK, Al Karaki V, Medawar J, et al. Distal tibial metaphyseal fractures in children treated by intrafocal pinning: a case report. Int J Foot Ankle 2021; 5(3): 59.","journal-title":"Int J Foot Ankle"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpo.0000218523.82996.76"},{"issue":"3","key":"e_1_3_2_5_2","first-page":"532","article-title":"Pediatric tibial shaft and distal metaphyseal fractures","volume":"31","author":"Civan O","year":"2020","unstructured":"Civan O, Alimo\u011flu B, \u0130\u00e7en M, et al. Pediatric tibial shaft and distal metaphyseal fractures. Joint Dis Relat Surg 2020; 31(3): 532\u2013540.","journal-title":"Joint Dis Relat Surg"},{"key":"e_1_3_2_6_2","volume-title":"Rang\u2019s children\u2019s fractures","author":"Rang M","year":"2005","unstructured":"Rang M, Pring ME, Wenger DR. Rang\u2019s children\u2019s fractures. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005.","edition":"3"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011421S00801"},{"issue":"5","key":"e_1_3_2_8_2","first-page":"407","article-title":"Failures and complications in intramedullary stabilization of pediatric fractures with elastic stable intramedullary nails (ESIN)","volume":"6","author":"Fernandez FF","year":"2012","unstructured":"Fernandez FF, Langend\u00f6rfer M, Wirth T, et al. Failures and complications in intramedullary stabilization of pediatric fractures with elastic stable intramedullary nails (ESIN). J Child Orthop 2012; 6(5): 407\u2013413.","journal-title":"J Child Orthop"},{"issue":"6","key":"e_1_3_2_9_2","first-page":"599","article-title":"Distal tibial metaphyseal fractures in children: does initial displacement predict outcomes?","volume":"34","author":"Hansen LB","year":"2014","unstructured":"Hansen LB, Grisoni N, Holmes LJr, et al. Distal tibial metaphyseal fractures in children: does initial displacement predict outcomes? J Pediatr Orthop 2014; 34(6): 599\u2013604.","journal-title":"J Pediatr Orthop"},{"key":"e_1_3_2_10_2","first-page":"43","article-title":"Outcome of non-operative management in pediatric metaphyseal tibial fractures with and without fibula fracture","volume":"7","author":"Rohilla R","year":"2016","unstructured":"Rohilla R, Yadav RK, Wadhwani J, et al. Outcome of non-operative management in pediatric metaphyseal tibial fractures with and without fibula fracture. J Clin Orthop Trauma 2016; 7(Suppl. 1): 43\u201347.","journal-title":"J Clin Orthop Trauma"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpo.0000187989.64021.ml"}],"container-title":["Journal of Children's Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18632521261436703","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/18632521261436703","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18632521261436703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T07:00:41Z","timestamp":1785567641000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/18632521261436703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,12]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/18632521261436703"],"URL":"https:\/\/doi.org\/10.1177\/18632521261436703","relation":{},"ISSN":["1863-2521","1863-2548"],"issn-type":[{"value":"1863-2521","type":"print"},{"value":"1863-2548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,12]]}}}