Incidence of Tibio-fibular Shaft and Ankle Fractures in Children

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Abstract
The incidence of tibio-fibular shaft and ankle fractures in children aged 0-18 yr was calculated. Of 919 fractures treated, 746 fractures occurred in the chosen population. The accumulated incidence of tibio-fibular shaft fractures in children 0-18 yr of age was 190 and 110/10,000 boys and girls, respectively; the accumulated incidence of ankle fractures was slightly less (172) in boys, but higher (141) in girls. The accumulated incidence of physeal fractures of distal tibia and/or fibula was 118 in boys and 90 in girls including tibio-fibular shaft fractures associated with ankle fractures. The accumulated incidence of ankle fractures without growth plate fracture in children with open growth plates was 13 in boys and 19 in girls. Longitudinal tibio-fibular shaft fractures occurred at the same age in boys and girls; transverse fractures occurred at an older age in boys mainly due to traffic accidents and sports. Ankle fractures occurred at an older age than tibio-fibular shaft fractures. Injuries classified as supination-eversion and supination-adduction were the most common types, but supination-eversion injuries occurred at an older age than supination-adduction injuries. The traumatological classification by Gerner-Smidt was compared with the anatomical classification by Salter and Harris. The traumatological classification failed to classify 14 cases (5%); 48 (17%) of the physeal fractures could not be classified according to Salter and Harris. Of these, 33 showed combinations of physeal fractures, 9 showed a zig-zag pattern, and 6 were undeterminable. Rotational trauma to the lower leg apparently results in a longitudinal fracture in the older child. No corresponding relation between transverse tibio-fibular shaft fractures and ankle fractures due to bending could be found.

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