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Tibial and fibular fractures

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • Of the 540 studies reviewed, five comparative studies addressed tibial and fibular fractures 1-5
  • One study noted 96% (23/24) of all tibial or fibular fractures were abusive in children under 18 months 1
  • In children less than three years old, 14 / 35 tibial and fibular fractures were from abuse 3
  • A small study identified abuse in 1 / 8 tibial and fibular fractures 2
  • Worlock reported abusive tibial and fibular fractures in children < 18 months of age but not in older toddlers 5
  • 7/12 abusive tibial fractures in infants were metaphyseal 5
  • Tibia and fibular fractures were commoner in abuse than accidental injury (p< 0.001) in children under four years old 4
  • The odds ratio (OR) for abuse in a child aged less than 18 months with a tibial / fibular fracture is 12.8 (95% confidence interval (CI) 5.1, 32.6) p<0.001 4
  • The OR for abuse in a child older than 18 months is 2.1 (95%CI 0.7, 6.2) p=0.172 4

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  1. Coffey C, Haley K, Hayes J, Groner JI. The risk of child abuse in infants and toddlers with lower extremity injuries. Journal of Pediatric Surgery. 2005;40(1):120-123 [Pubmed]
  2. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  3. Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children. Distinguishing child abuse from unintentional injuries. American Journal of Diseases of Children. 1993;147(1):87-92 [Pubmed]
  4. Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS. Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. Journal of Pediatric Orthopaedics. 2009;29(6):618-625 [Pubmed]
  5. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. British Medical Journal (Clinical Research Edition). 1986;293(6539):100-102 [Pubmed]


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