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An Increasing Rate of Surgical Management of Closed Tibia Fractures in an Adolescent Population: A National Database Study.

BACKGROUND
No consensus exists for the management of closed tibia fractures in the adolescent population.


METHODS
The Kids' Inpatient Database was used to extract data on patients aged 10 to 18 years with closed diaphyseal tibia fractures. The frequency of closed reduction and internal fixation (IF) was calculated, and the temporal trends were evaluated.


RESULTS
Between 1997 and 2012, the rate of IF for closed tibia fractures in the adolescent population increased by 29.8%. The rate of increase in IF between patients aged 10 to 12 years, 13 to 15 years, and 16 to 18 years was not statistically different (P = 0.092). Analysis of hospital variables demonstrated that large hospitals were more likely to perform IF compared with small- and medium-sized hospitals (P < 0.001). A significant difference exists between the IF and closed reduction groups in the length of hospital stay (3.85 ± 0.07 versus 2.44 ± 0.07; P < 0.001) and cost ($37,400 ± $890 versus $15,300 ± $670; P < 0.001).


DISCUSSION
The results of this study show a shift in the management of closed tibia shaft fractures in the adolescent population admitted to the hospital, with an absolute rate increase of 29.8% in patients aged 10 to 18 years over a 15-year period.


LEVEL OF EVIDENCE
Level III. A retrospective, comparative study.