- Original article
- Open Access
Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture
Journal of Orthopaedics and Traumatology volume 22, Article number: 12 (2021)
This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures.
Materials and methods
This study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD < 1 cm and ≥ 1 cm and overgrowth < 1 cm and ≥ 1 cm.
Casting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLDs < 1 cm and ≥ 1 cm. There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with overgrowth < 1 cm and ≥ 1 cm. Sex and treatment methods were risk factors associated with LLD ≥ 1 cm and overgrowth ≥ 1 cm following pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm and 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm and 4.8-fold higher risk of overgrowth ≥ 1 cm than those treated by casting.
Patients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys.
Level of evidence
Tibial shaft fractures account for about 1.1% of all pediatric fractures and are the second most common long bone fracture in a child, after forearm fractures [1, 2]. In addition, tibial and fibular fractures account for 21.5% of pediatric orthopedic trauma hospitalizations and are the second most frequent injury, after femoral fractures . Also, for pediatric patients with polytrauma, tibia is the third most common fracture site after femur and humerus [4, 5].
A closed reduction followed by casting for pediatric tibial shaft fractures is the mainstay treatment method. Surgical treatment methods include external fixation, intramedullary nailing, crossed Kirschner wire fixation, and plate fixation. For intramedullary fixation, flexible intramedullary nails such as titanium elastic nails are mainly used rather than rigid intramedullary nails to prevent epiphyseal injuries of the proximal tibia. Treatment methods depend on the patient’s age, weight, fracture pattern, and the surgeon’s preference [6,7,8,9,10,11,12].
One of the common sequelae after a pediatric tibial shaft fracture is leg length discrepancy (LLD) owing to overgrowth of the injured tibia . According to a number of studies that investigated the biomechanical effects of LLD, back pain, hip pain, and stress fractures have been reported as musculoskeletal disorders associated with LLD [14,15,16]. Most of the overgrowth has been shown to occur within 18 months after the fracture, and the average overgrowth at the time of follow-up was approximately 6 mm in cases of tibial shaft fractures . This is thought to be due to the physiological processes associated with posttraumatic activation of the growth plate [18, 19].
Several studies have investigated the risk factors associated with overgrowth after pediatric femur shaft fracture, which included age, fracture site, fracture stability, and nail-to-canal diameter ratio [17, 20,21,22,23,24,25,26]. However, few studies have analyzed the risk factors for LLD and overgrowth after a tibial shaft fracture in children. Therefore, the aim of this study was to investigate LLD and overgrowth after a pediatric tibial shaft fracture and its associated risk factors.
Materials and methods
The study protocol was approved by the institutional review board of our institution, and the requirement of informed consent from the participants was waived because of the retrospective nature of the study.
Study population and data collection
We reviewed and retrieved the information of consecutive patients with a tibial shaft fracture between January 2003 and November 2018. Of these, patients with a unilateral tibial shaft fracture who were younger than 14 years of age and had a minimum follow-up of 24 months were included in this study. The exclusion criteria were as follows: (1) bilateral tibial shaft fracture, (2) ipsilateral or contralateral lower limb fractures, or (3) pathologic fracture due to congenital pseudoarthrosis, cerebral palsy, bone tumor, or osteogenesis imperfecta.
Through the examination of medical records, information such as sex, age, body mass index (BMI), follow-up duration, side of limb, injury mechanism, and treatment method was obtained. Injury mechanisms were divided into high-energy and low-energy injuries. Traffic accidents and falling from high places were defined as high-energy injuries, and slipping and falling from ground level was defined as low-energy injuries. All patients were treated by two pediatric orthopedic surgeons (MSP and KHS). Treatment methods included casting and titanium elastic nailing (TEN).
All surgical procedures were performed under general anesthesia. The fractured limbs were cleaned and draped with the patient lying in the supine position. TEN was performed with antegrade methods after obtaining the appropriate reduction through closed manipulation under C-arm fluoroscopy. To prevent damage to the proximal physis of fractured tibia, medial and lateral proximal entry points were set at a distal position from the proximal epiphysis. A 2–3 cm longitudinal skin incision was made as a set entry point, and then cortical holes were made using an awl. Two titanium elastic nails with a diameter corresponding to the target of 80% of the total canal fill at the isthmus were adequately bent and inserted into the lateral and medial entry points. While confirming fracture reduction with C-arm fluoroscopy, the titanium elastic nails were advanced to the distal side of the fracture. Following confirmation of fracture reduction and positioning of the titanium elastic nails under fluoroscopic guidance, the tips of the titanium elastic nails were bent and cut away from the bone surface.
The radiographs of the patients were captured using a UT 2000 X-ray machine (Philips Research; Eindhoven, the Netherlands) according to our protocol, which is as follows: the anteroposterior (AP) and lateral radiographs included the tibia as a whole (from knee to ankle), while the beam was focused on the middle part. To assess limb length, AP standing long-cassette radiographs of the lower extremity (teleradiogram) were obtained by vertically entering the horizontal center beam to the patella height and vertical beam to the midline. The radiograph setting was 50 kVp and 5 mAs at a source-to-image distance of 200 cm with the patella facing forward. Until 2 years after the trauma, a teleradiogram was taken regularly once per year, because most of the overgrowths occur within 2 years after injury. Thereafter, if the LLD ≥ 1 cm, teleradiogram is recommended to be performed regularly once every 1–2 years. Otherwise, a regular examination was decided according to the parents’ need. All radiographic images were acquired digitally using a picture archiving and communication system (PACS, Infinitt; Seoul, South Korea), and radiographic measurements were performed using PACS software.
Fracture location and fracture stability were determined from the preoperative anteroposterior (AP) and lateral radiographs of the injured tibia. Fracture locations were classified as follows: proximal one-third, middle one-third, and distal one-third. Fractures were divided into length-stable and length-unstable fractures according to fracture stability. Transverse and short oblique fractures were classified as length-stable fractures; and long oblique, spiral, and comminuted fractures were classified as length-unstable fractures. Long oblique fractures were defined as when the angle between the fracture line and a line perpendicular to the long axis of the tibia was > 30°. From the postoperative AP and lateral radiographs of the tibia, fracture-site shortening was measured.
Whole limb length (WLL) was measured from the teleradiogram implemented at the time of the last follow-up, and the length from the top of the femoral head to the center of the tibial plafond was defined as WLL. LLD was measured as the injured limb length minus the uninjured limb length. Overgrowth was calculated by adding the fracture site shortening from the LLD. To investigate the risk factors for LLD and overgrowth, we divided our patients into those with LLD of < 1 cm or ≥ 1 cm, and those with an overgrowth of < 1 cm or ≥ 1 cm.
Descriptive statistical analysis was performed including the mean, standard deviation (SD), and proportion to summarize patient demographics. A comparison of variables between groups was performed using a Student’s t-test and the χ2 test. Multivariate logistic regression analysis was performed to identify the risk factors for an LLD ≥ 1 cm and overgrowth ≥ 1 cm in patients with a pediatric tibial shaft fracture. All statistical analyses were performed using SPSS software for Windows (Version 25.0; SPSS, Inc.; Chicago, IL, USA), and statistical significance was accepted when the p-values were < 0.05.
A total of 103 patients with a tibial shaft fracture were included in the analysis. The mean age of the patient at the time of fracture was 7.2 ± 3.3 years, and there were 75 (72.8%) boys and 28 (27.2%) girls.
There were 6 proximal one-third (5.8%), 40 middle one-third (38.8%), and 57 distal one-third (55.4%) fracture locations. In 24 patients (23.3%), the fracture was length stable; and in 79 patients (76.7%), it was length unstable. There were 66 high-energy (64.1%) and 37 low-energy (35.9%) injury mechanisms of fracture. The mean follow-up duration was 3.9 ± 2.0 years. Casting and TEN were performed on 64 (62.1%) and 39 (37.9%) patients, respectively, to treat tibial shaft fracture. The average fractured site shortening length that was observed after treatment was 0.8 ± 1.5 mm. The mean LLD and mean overgrowth were 5.6 ± 7.7 mm (95% confidence intervals [CI] 4.1–7.1) and 6.4 ± 7.6 mm (95% CI 4.9–7.9), respectively. Of the 103 patients, 24 (23.3%) had an LLD of ≥ 1 cm and 27 (26.2%) had an overgrowth of ≥ 1 cm (Table 1). Five patients (4.9%) had an LLD of more than 2 cm, and seven patients (6.0%) had an overgrowth of more than 2 cm. Three patients underwent epiphysiodesis, and one patient underwent tibial lengthening using an Ilizarov external fixator. One patient underwent hemiepiphysiodesis because of posttraumatic genu valgum.
There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLD < 1 cm and those with LLD ≥ 1 cm. However, there were no significant differences in BMI, side of limbs, fracture location, fracture stability, and follow-up duration between the two groups (Table 2).
There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with an overgrowth < 1 cm and those with an overgrowth ≥ 1 cm. However, there were no significant differences in age, BMI, side of limbs, fracture location, fracture stability, and follow-up duration between the two groups (Table 3).
There were significant differences in age (p = 0.041), fibular involvement (p < 0.001), and injury mechanism (p < 0.001) between cast and TEN treated patients. However, there were no significant differences in sex, BMI, side of limbs, fracture location, fracture stability, and follow-up duration between the two groups (Table 4).
Multivariate logistic regression analysis showed that sex (p = 0.014) and treatment methods (p = 0.011) were risk factors associated with an LLD ≥ 1 cm after pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm than the girls. Children who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm than those who underwent casting. However, other variables, including age, fracture location, fibular involvement, and injury mechanism, were not associated with LLD ≥ 1 cm after pediatric tibial shaft fracture (Table 5).
In addition, sex (p = 0.030) and treatment methods (p < 0.001) were risk factors associated with an overgrowth ≥ 1 cm after pediatric tibial shaft fracture. The boys had a 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.7-fold higher risk of overgrowth ≥ 1 cm than those who underwent casting. However, other variables, including age, fracture location, fibular involvement, and injury mechanism, were not associated with overgrowth ≥ 1 cm after pediatric tibial shaft fracture (Table 6).
In general, LLD has been accepted as a result of overgrowth of the fractured tibia or femur . If LLD at skeletal maturity exceeds or is expected to exceed 2–2.5 cm, length equalization procedures such as epiphysiodesis or limb lengthening should be considered . Therefore, it is clinically important to identify risk factors for LLD and overgrowth after a pediatric tibial shaft fracture. This study demonstrated that LLD and overgrowth after pediatric tibial shaft fractures was significantly associated with sex and treatment methods. The patients treated by TEN had greater LLD and overgrowth than those treated with casting, with the boys exhibiting greater LLD and overgrowth than the girls.
A number of studies have reported overgrowth and its risk factors after femur shaft fracture in children [17, 22,23,24]. They found that length-unstable fracture, low nail-to-canal diameter ratio, and younger age were associated with overgrowth after a pediatric femur shaft fracture.
There have only been two studies investigating LLD and overgrowth after a pediatric tibial shaft fracture. Stilli et al. assessed overgrowth in children who had received conservative treatment for femur and tibial shaft fractures  and found a greater amount of overgrowth in younger patients than in patients 5 years after conservative treatment. In addition, they showed that a greater amount of overgrowth was found in cases of diaphyseal fractures with a greater initial displacement, with significant angular deviation and overriding of bone fragments. Lee et al. assessed LLD in 27 patients with flexible intramedullary nail fixation for femur and tibial shaft fractures  and showed that a younger age at the time of injury was significantly associated with LLD.
In this study, sex and treatment methods were a significant factor for LLD ≥ 1 and overgrowth ≥ 1 cm after pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of having an LLD of ≥ 1 cm and a 5.4-fold higher risk of having an overgrowth of ≥ 1 cm than the girls. Moreover, the five patients who had an LLD of > 2 cm and seven patients who had an overgrowth of > 2 cm were all boys. It is tempting to postulate that hyperemia results in growth stimulation, which has a greater effect on the relatively dormant growth plate of boys . In addition, high-energy injuries are more frequent in boys who are relatively active compared with girls, and eventually, surgical treatment such as TEN may become more frequent than treatment with cast. This could be the reason for the high risk of LLD and overgrowth in boys. However, our study showed that boys had a greater LLD (3.0 mm) and overgrowth (2.6 mm) compared with girls, and this difference does not appear to be a clinically significant problem.
Patients treated with TEN had a 4.3-fold higher risk of having an LLD of ≥ 1 cm and a 4.7-fold higher risk of having an overgrowth ≥ 1 cm than those treated with casting. Among the five patients with an LLD of > 2 cm, four were initially treated with TEN and one with casting. Among the seven patients with an overgrowth of > 2 cm, six were initially treated with TEN and one with casting. Halanski et al. conducted an animal study to investigate the association between periosteum disruption and overgrowth after long bone fractures . They analyzed the growth rates after performing procedures to disrupt periosteal fibers on the tibia of skeletally immature rabbits and showed that growth acceleration occurred at both the proximal and distal tibial growth plates after the periosteal procedures. Generally, surgical treatment with TEN is performed rather than conservative treatment with casting when treating displaced pediatric tibial shaft fractures. The displacement of the fracture site may disrupt the periosteum; therefore, it may be reasonable for LLD and overgrowth to be observed in patients treated with TEN rather than with casting.
Canavese et al. reported that there was no significant difference in the results between nonoperative management and operative treatment with elastic stable intramedullary nailing for patients with immature skeleton who had displaced tibial fractures but no associated fibula fractures . Marengo et al. demonstrated that the use of elastic stable intramedullary nailing for displaced tibial shaft fractures in children and adolescents aged ≥ 11 years and weighing ≥ 50 kg did not lead to worse outcomes . Furthermore, our study results showed that age, BMI, and presence of fibular involvement were not risk factors for LLD and overgrowth in patients with pediatric tibial shaft fracture.
There were limitations to this study. First, the minimum follow-up duration of our cohort was 24 months, which may affect the study outcomes. However, there was no significant difference in follow-up duration between patients with LLD < 1 cm and ≥ 1 cm, and between patients with overgrowth < 1 cm and ≥ 1 cm. In addition, our analysis showed that follow-up duration was not associated with LLD and overgrowth after pediatric tibial shaft fractures. Further long-term follow-up studies are required. Second, this study included TEN as a surgical treatment method and did not include other fixation methods, such as external fixation and plating. Our study showed that LLD and overgrowth are more likely to occur when patients are treated with TEN compared with when patients are treated with casting, although lesser complications have been reported for TEN than for other techniques (plate fixation, external fixation) [32, 33]. Further study including patients treated using other surgical techniques is needed. Third, the study population between patients treated with casting and TEN is not homogeneous (64 versus 39) due to the retrospective nature of this study, which might be a bias affecting the study results. To control the bias, we performed multivariate analysis for identifying the risk factors. Therefore, we think that our study may provide clinically meaningful results. Fourth, this study included patients aged < 14 years; thus, the age range was wide. The degree of overgrowth may vary depending on the residual potential of growth from the time of injury. However, our multivariate analysis showed that age was not associated with the risk of LLD or overgrowth occurring after tibial shaft fractures in pediatric cases. A further study with a narrow range of age groups is needed.
In conclusion, the patients who underwent TEN showed greater LLD and overgrowth than those who underwent casting, with boys exhibiting greater LLD and overgrowth than girls. However, it is difficult to say whether the results have clinical significance because the differences in LLD and overgrowth were not significant between sexes and treatment methods. Nevertheless, because the parents of pediatric patients find it difficult to accept even a slight LLD or overgrowth as a result of the fracture, surgeons need to consider the possibility of LLD and overgrowth in pediatric tibial shaft fracture cases, especially when performing TEN for boys.
Availability of data and materials
The dataset supporting the conclusion of this article is available on request to the corresponding author.
Leg length discrepancy
Titanium elastic nailing
Body mass index
Whole limb length
Waters PM, Skaggs DL, Flynn JM, Court-Brown CM (2020) Rockwood and Wilkins’ fractures in children, 9th edn. Wolters Kluwer, Philadelphia
Naranje SM, Erali RA, Warner WC Jr, Sawyer JR, Kelly DM (2016) Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop 36(4):e45–e48
Galano GJ, Vitale MA, Kessler MW, Hyman JE, Vitale MG (2005) The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 25(1):39–44
Buckley SL, Gotschall C, Robertson W Jr, Sturm P, Tosi L, Thomas M, Eichelberger M (1994) The relationships of skeletal injuries with trauma score, injury severity score, length of hospital stay, hospital charges, and mortality in children admitted to a regional pediatric trauma center. J Pediatr Orthop 14(4):449–453
Raducha JE, Swarup I, Schachne JM, Cruz AI Jr, Fabricant PD (2019) Tibial shaft fractures in children and adolescents. JBJS Rev 7(2):e4
Pandya NK, Edmonds EW (2012) Immediate intramedullary flexible nailing of open pediatric tibial shaft fractures. J Pediatr Orthop 32(8):770–776
Heo J, Oh CW, Park KH, Kim JW, Kim HJ, Lee JC, Park IH (2016) Elastic nailing of tibia shaft fractures in young children up to 10 years of age. Injury 47(4):832–836
Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Koval KJ (2005) Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am 87(8):1761–1768
Myers SH, Spiegel D, Flynn JM (2007) External fixation of high-energy tibia fractures. J Pediatr Orthop 27(5):537–539
Ligier JN, Metaizeau JP, Prevot J, Lascombes P (1985) Elastic stable intramedullary pinning of long bone shaft fractures in children. Z Kinderchir 40(4):209–212
Patel NK, Horstman J, Kuester V, Sambandam S, Mounasamy V (2018) Pediatric tibial shaft fractures. Indian J Orthop 52(5):522–528
Uludag A, Tosun HB (2019) Treatment of unstable pediatric tibial shaft fractures with titanium elastic nails. Medicina 55(6):266
Lee SH, Hong JY, Bae JH, Park JW, Park JH (2015) Factors related to leg length discrepancy after flexible intramedullary nail fixation in pediatric lower-extremity fractures. J Pediatr Orthop B 24(3):246–250
Khamis S, Carmeli E (2018) The effect of simulated leg length discrepancy on lower limb biomechanics during gait. Gait Posture 61:73–80
Rannisto S, Okuloff A, Uitti J, Paananen M, Rannisto PH, Malmivaara A, Karppinen J (2015) Leg-length discrepancy is associated with low back pain among those who must stand while working. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-015-0571-9
Campbell TM, Ghaedi BB, Tanjong Ghogomu E, Welch V (2018) Shoe lifts for leg length discrepancy in adults with common painful musculoskeletal conditions: a systematic review of the literature. Arch Phys Med Rehabil 99(5):981-993 e2
Stilli S, Magnani M, Lampasi M, Antonioli D, Bettuzzi C, Donzelli O (2008) Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children. Chir Organi Mov 91(1):13–19
Janezic G, Widni EE, Haxhija EQ, Stradner M, Frohlich E, Weinberg AM (2010) Proliferation analysis of the growth plate after diaphyseal midshaft fracture by 5′-bromo-2′-deoxy-uridine. Virchows Arch 457(1):77–85
Etchebehere EC, Caron M, Pereira JA, Lima MC, Santos AO, Ramos CD, Barros FB, Sanches A, Santos-Jesus R, Belangero W, Camargo EE (2001) Activation of the growth plates on three-phase bone scintigraphy: the explanation for the overgrowth of fractured femurs. Eur J Nucl Med 28(1):72–80
Martin-Ferrero MA, Sanchez-Martin MM (1986) Prediction of overgrowth in femoral shaft fractures in children. Int Orthop 10(2):89–93
Park KH, Park BK, Oh CW, Kim DW, Park H, Park KB (2020) Overgrowth of the femur after internal fixation in children with femoral shaft fracture—a multicenter study. J Orthop Trauma 34(3):e90–e95
Park SS, Noh H, Kam M (2013) Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children. Bone Joint J 95-B(2):254–258
Dai CQ, Yang J, Guo XS, Sun LJ (2015) Risk factors for limb overgrowth after the application of titanium elastic nailing in the treatment of pediatric femoral fracture. J Orthop Sci 20(5):844–848
Sulaiman AR, Joehaimy J, Iskandar MA, Anwar Hau M, Ezane AM, Faisham WI (2006) Femoral overgrowth following plate fixation of the fractured femur in children. Singap Med J 47(8):684–687
Corry IS, Nicol RO (1995) Limb length after fracture of the femoral shaft in children. J Pediatr Orthop 15(2):217–219
Hariga H, Mousny M, Docquier PL (2011) Leg length discrepancy following femoral shaft fracture in children: clinical considerations and recommendations. Acta Orthop Belg 77(6):782–787
Herring JA, Tachdjian MO (2002) Tachdjian’s pediatric orthopaedics, 3rd edn. Saunders, Philadelphia
Clement DA, Colton CL (1986) Overgrowth of the femur after fracture in childhood. An increased effect in boys. J Bone Joint Surg Br 68(4):534–536
Sabharwal S (2016) CORR insights®: periosteal fiber transection during periosteal procedures is crucial to accelerate growth in the rabbit model. Clin Orthop Relat Res 474(4):1038–1040
Canavese F, Botnari A, Andreacchio A, Marengo L, Samba A, Dimeglio A, Pereira B, Mansour M, Rousset M (2016) Displaced tibial shaft fractures with intact fibula in children: nonoperative management versus operative treatment with elastic stable intramedullary nailing. J Pediatr Orthop 36(7):667–672
Marengo L, Paonessa M, Andreacchio A, Dimeglio A, Potenza A, Canavese F (2016) Displaced tibia shaft fractures in children treated by elastic stable intramedullary nailing: results and complications in children weighing 50 kg (110 lb) or more. Eur J Orthop Surg Traumatol 26(3):311–317
Bar-On E, Sagiv S, Porat S (1997) External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br 79(6):975–978
Shen K, Cai H, Wang Z, Xu Y (2016) Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children. Medicine 95(39):e4980
Ethics approval and consent to participate
This retrospective study was approved by the institutional review board at our institution, and the requirement for informed consent was waived.
Consent for publication
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Choi, W.Y., Park, M.S., Lee, K.M. et al. Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture. J Orthop Traumatol 22, 12 (2021). https://doi.org/10.1186/s10195-021-00575-x
- Leg length discrepancy
- Tibial shaft fracture