Tibial Fractures: Treatment, Surgery, and Growth Concerns

Tibial fracture

Hello: My daughter suffered a tibial fracture in a car accident on September 5, 2018.
She underwent surgery at that time, where a steel plate was used for fixation.
The plate was removed the following July, and upon further observation, it was discovered that she has a leg length discrepancy of nearly 1.9 cm, which appears to be increasing over time.
A full-body X-ray also indicated a slight pelvic tilt.
The doctor has suggested performing a growth plate suppression surgery (8-plate) to correct this issue.
I would like to ask the doctor: 1.
Are there any precautions to take with this surgery, and will there still be a problem with leg length discrepancy? 2.
Is this surgery considered minimally invasive, and will the surgery time and recovery be quicker? 3.
After this surgery, will she need to supplement anything to help with growth and achieve equal leg length? I look forward to your advice.
Thank you~~

Liu Xiaojie, 40~49 year old female. Ask Date: 2020/12/10

Dr. Wang Shouji reply Orthopedics

Hello, if a pediatric fracture affects the growth plate, it can sometimes lead to asymmetrical growth.
In such cases, it is necessary to suppress the growth on one side to prevent increasing deformity and to correct the malalignment.
We will only know if there is still a leg length discrepancy after full development.
The surgical incision for this type of procedure is smaller compared to previous surgeries.
Postoperatively, it is important to ensure adequate calcium supplementation and regular follow-up.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2020/12/10

More Info

Understanding tibial fractures, especially in children, involves a comprehensive approach that includes treatment options, surgical interventions, and considerations for growth and development. Your daughter's case of tibial fracture followed by surgery and subsequent issues with leg length discrepancy is not uncommon, and it raises several important questions regarding her treatment and future growth.

1. Surgical Considerations and Leg Length Discrepancy: The surgery your daughter underwent to fix the tibial fracture using a plate is a standard procedure aimed at stabilizing the bone to allow for proper healing. However, complications such as leg length discrepancies can occur, especially in growing children. The recommendation for a growth plate suppression surgery (often referred to as an "8-plate" procedure) is a method used to slow down the growth of the longer leg to allow the shorter leg to catch up. This procedure is typically performed when there is a significant difference in leg length, and it can be effective in correcting discrepancies over time.
It is essential to discuss with the orthopedic surgeon the specific risks and benefits of this surgery, including the potential for further discrepancies if growth patterns do not normalize after the procedure. Regular follow-up appointments will be crucial to monitor her growth and ensure that the legs are developing symmetrically.

2. Minimally Invasive Surgery: The 8-plate procedure is considered a minimally invasive technique compared to traditional methods. The surgery generally involves smaller incisions and can lead to quicker recovery times. However, the exact duration of the surgery and recovery can vary based on individual circumstances, including the complexity of the case and the child's overall health. Typically, children can resume normal activities relatively quickly, but full recovery and monitoring will be necessary to ensure that the growth plates are responding as expected.

3. Nutritional Support for Growth: Post-surgery, it is vital to support your daughter's growth through proper nutrition. A balanced diet rich in calcium, vitamin D, and protein is essential for bone health and growth. Calcium is crucial for bone density, while vitamin D helps in calcium absorption. Additionally, ensuring that she has adequate protein intake will support muscle development and overall recovery. Depending on her dietary habits, a pediatrician or nutritionist may recommend specific supplements to ensure she meets her nutritional needs.

4. Monitoring and Follow-Up: After the surgery, regular follow-up appointments with the orthopedic surgeon will be necessary to monitor her leg length and overall growth. X-rays will likely be taken periodically to assess the healing process and the effectiveness of the growth plate suppression. It is also important to keep an open line of communication with her healthcare team regarding any concerns or changes in her condition.

5. Physical Therapy: Engaging in physical therapy post-surgery can also be beneficial. A physical therapist can provide exercises tailored to strengthen the muscles around the knee and improve overall mobility, which can be particularly important if there has been any impact on her gait due to the leg length discrepancy.

In summary, your daughter's situation is complex but manageable with the right approach. The growth plate suppression surgery can help address the leg length discrepancy, and with proper care, nutrition, and follow-up, she can achieve a more balanced growth pattern. Always consult with her orthopedic surgeon for personalized advice and to address any specific concerns you may have.

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