Overview
Pathological fractures of the lower leg involve bone weakened by underlying pathology leading to fracture with minimal trauma. These fractures require careful management to address both the fracture and the underlying condition 1.Diagnosis
Clinical history and physical examination crucial for identifying predisposing conditions.
Radiography essential for confirming fracture type and location.
Advanced imaging (CT, MRI) may be needed to assess bone pathology and soft tissue involvement 1.Management
Non-operative treatment: Suitable for non-displaced, reducible, and stable fractures; requires close monitoring and prolonged immobilization (often >3 months) 1.
Elastic Stable Intramedullary Nailing (ESIN): Preferred for children preferring shorter immobilization periods or for unstable fractures 1.
Internal fixation: Screw-plate fixation, rigid intramedullary nailing, or external fixation considered based on fracture specifics 1.
Close monitoring: Essential for early detection of complications such as compartment syndrome 1.Special Populations
Pediatrics: Non-operative treatment standard for stable fractures; ESIN offered as an alternative to reduce immobilization time 1.Key Recommendations
Non-operative treatment is the reference standard for stable, non-displaced lower leg fractures in children, though prolonged immobilization is required (Evidence: Moderate 1).
Elastic Stable Intramedullary Nailing (ESIN) should be considered for children preferring shorter immobilization periods or for unstable fractures (Evidence: Moderate 1).
Close monitoring during the acute phase is crucial to promptly identify and manage complications like compartment syndrome (Evidence: Expert opinion 1).References
1 Metaizeau JD, Denis D. Update on leg fractures in paediatric patients. Orthopaedics & traumatology, surgery & research : OTSR 2019. link