Increasing rates of surgical treatment for paediatric tibial shaft fractures: a national database study from between 2000 and 2012

PURPOSE: Tibia fractures are the third most common long bone fracture in children. Because of the remodelling potential of the tibial diaphysis, nonoperative treatment has historically been advocated for most tibial shaft fractures in children. The purpose of this study was to estimate the rate of surgical treatment of tibial shaft fractures over time and identify demographic factors associated with surgical treatment, utilizing a large, publicly available, national database. METHODS: The Healthcare Cost and Utilization Project Kids’ Inpatient Database was evaluated for the years between 2000 and 2012. Tibial shaft fractures and surgically treated patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. Univariable and multivariable logistic regression were used to determine variables associated with a greater proportion of surgical treatment. Statistical analyses were performed utilizing SAS statistical software v.9.4. Statistical significance was set at p < 0.05. RESULTS: In all, 24 166 tibial shaft fracture admissions were identified, with 15 621 (64.7%) treated surgically. The percentage of patients receiving surgery to treat tibial shaft fractures increased from 57.3% in 2000 to 74.3% in 2012 (p < 0.001). Multivariable regression showed that increasing age was associated with increased rate of surgical treatment (p < 0.001). The greatest increase in surgical treatment was seen in children aged five to nine years, increasing from 23.0% in 2000 to 46.2% in 2012. CONCLUSION: The rate of operative treatment of paediatric tibial shaft fractures increased over time. The largest increase was seen in children aged five to nine years. Increased proportion of surgical treatment was associated with older age, concurrent femur fracture and non-Medicaid insurance status. LEVEL OF EVIDENCE: Level III - Retrospective comparative study