Tibial Fractures and Osteogenesis Imperfecta in Children

Q: Tibial Fractures and Osteogenesis Imperfecta in Children

Hello： 1. <br>The effectiveness of rehabilitation therapy varies from person to person, especially in children where the differences can be significant. <br>Please be patient and cooperate with the rehabilitation therapy for six months. <br>2. <br>Normal removal of internal fixat

Tibial fracture/Osteogenesis imperfecta (OI)

Hello, Doctor: My child, who is 8 years old, suffered an injury in a car accident resulting in a spiral fracture of the left tibial shaft.
The doctor used a telescopic intramedullary nail with two fixation screws.
I would like to ask the following questions, and I hope you can provide answers:
1.
My child has been actively rehabilitating every day for the past three months, but still walks with a limp.
Is there a possibility of returning to normal?
2.
What is the typical time frame for removing the metal screws? Is the surgery to remove the intramedullary nail risky or complicated? Will hospitalization be required? Does it matter if the original doctor does not perform the removal?
3.
We consulted a pediatric orthopedic specialist, who estimated a possibility of osteogenesis imperfecta, and genetic testing has been done.
Are there other options available? Is a bone density test necessary?
4.
My child is currently unable to stand still and experiences pain in the soles of the feet.
Is this normal?
5.
Will there be an issue with leg length discrepancy? How can this be prevented?
6.
After the removal of the metal screws, how long does the child need to rest, and will rehabilitation still be necessary?

Miss Zeng, 0~9 year old female. Ask Date: 2023/12/18

Dr. Li Wenhong reply Orthopedics

Hello: 1.
The effectiveness of rehabilitation therapy varies from person to person, especially in children where the differences can be significant.
Please be patient and cooperate with the rehabilitation therapy for six months.
2.
Normal removal of internal fixation devices requires the fracture to heal, and weight-bearing on the lower extremities typically takes over a year, although children may heal sooner.
The surgery itself is not complicated, but any surgery carries risks.
Hospitalization is necessary, and it is better for the original surgeon to remove the screws, as special tools may be required for removal.
3.
The diagnosis of osteogenesis imperfecta primarily relies on clinical symptoms, supplemented by genetic testing.
Bone density testing can be performed, but it serves only as a reference for one's bone quality to see if there is an increase, as there is no database for comparison.
4.
If there is pain or inability to stand, please report this to the attending physician during follow-up visits.
5.
Generally, mild cases of osteogenesis imperfecta result in smaller stature without leg length discrepancies.
It is important to prevent fractures, and if a fracture occurs, measures should be taken to prevent improper healing (such as bone deformities).
6.
After screw removal, no rest is needed; just ensure the wound is protected to prevent infection, avoid vigorous exercise, and rehabilitation is not necessary.
Changhua Hospital, Orthopedics, Dr.
Li Wen-Hong.

Reply Date: 2023/12/18

More Info

Understanding tibial fractures in children, particularly in the context of osteogenesis imperfecta (OI), is crucial for effective management and recovery. Given your child's recent spiral fracture of the left tibia due to a car accident and the subsequent treatment with intramedullary nails, let's address your questions systematically.

1. Recovery and Gait Issues: It is common for children to experience some gait abnormalities after a tibial fracture, especially if the injury was significant. The fact that your child is actively participating in rehabilitation is a positive sign. With consistent physical therapy, many children can regain normal walking patterns. The recovery timeline can vary based on the severity of the fracture, the child's age, and their overall health. It is essential to continue rehabilitation exercises, focusing on strength, balance, and coordination, to improve gait.

2. Timing and Risks of Hardware Removal: The typical timeframe for removing intramedullary nails is usually between 6 to 12 months post-surgery, depending on the healing process and the surgeon's assessment. The removal procedure is generally considered safe, but like any surgery, it carries risks such as infection, bleeding, and complications related to anesthesia. The complexity of the procedure can vary based on the individual case, but it is often done on an outpatient basis, meaning your child may not need to stay overnight in the hospital. If you choose to have another surgeon perform the removal, it is essential to provide them with all relevant medical records and imaging to ensure continuity of care.

3. Osteogenesis Imperfecta and Further Testing: Osteogenesis imperfecta is a genetic disorder characterized by fragile bones. If your child has been suspected of having OI, genetic testing is a crucial step in confirming the diagnosis. Besides genetic testing, a bone density scan (DEXA) can provide valuable information about bone strength and density, which is particularly important in managing OI. This information can guide treatment decisions, including the need for medications that strengthen bones.

4. Standing and Foot Pain: It is not uncommon for children recovering from a tibial fracture to experience difficulty with weight-bearing and foot pain. This can be due to several factors, including muscle weakness, joint stiffness, or even compensatory gait patterns. If your child is unable to stand properly or experiences persistent pain, it is essential to consult with a pediatric orthopedic specialist to evaluate the situation further.

5. Leg Length Discrepancy: There is a potential risk of leg length discrepancy following a tibial fracture, especially in children whose bones are still growing. Factors such as the type of fracture, the treatment method, and the child's growth patterns can influence this risk. Regular follow-ups with an orthopedic specialist can help monitor growth and identify any discrepancies early. Preventive measures include ensuring proper alignment during healing and engaging in physical therapy to promote balanced muscle development.

6. Post-Removal Recovery and Rehabilitation: After the removal of intramedullary nails, children typically need some time to recover, which can range from a few days to a couple of weeks, depending on the individual case. Rehabilitation is often necessary to regain strength and mobility. A tailored physical therapy program can help your child transition back to normal activities and address any lingering issues related to the fracture.

In summary, while your child’s recovery from a tibial fracture may present challenges, with appropriate medical care, rehabilitation, and monitoring, there is a strong possibility of returning to normal function. Regular follow-ups with pediatric orthopedic specialists are essential to ensure that any complications are addressed promptly and that your child receives the best possible care.

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