Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug;17(4):696-703.
doi: 10.4055/cios24350. Epub 2025 Jul 15.

Tibial Overgrowth and Ipsilateral Femoral Overgrowth after the Fracture of Tibial Shaft in Children

Yoon Joo Cho  1 , Jae Hyun Ahn  1 , You Seung Chun  2
Affiliations

Tibial Overgrowth and Ipsilateral Femoral Overgrowth after the Fracture of Tibial Shaft in Children

Yoon Joo Cho et al. Clin Orthop Surg. 2025 Aug.

Abstract

Background: Overgrowth of the limb often occurs after pediatric tibial shaft fractures; however, risk factors for this phenomenon differ across studies. In addition, overgrowth of the ipsilateral femur is not well known. This study aimed to analyze ipsilateral femoral overgrowth after pediatric tibial shaft fracture and to compare the risk factors for tibial and ipsilateral femoral overgrowth.

Methods: Among the 85 patients who were diagnosed with tibial shaft fractures between January 2012 and December 2022 under the age of 14 years and followed up for more than a year, 6 patients who had missing initial plain radiographs, associated fractures or bone lesions in the lower extremities, or reoperation due to complications were excluded. After exclusion, 79 patients were included in this retrospective study. Medical records and radiographic data were collected, including information on tibial overgrowth, femoral overgrowth, and leg-length discrepancy (LLD) at the latest follow-up. Age, sex, laterality, fracture stability, fracture location, fracture comminution, fibular involvement, open or closed fractures, fracture site shortening, and treatment type were selected as variables for univariate and age-sex adjusted multiple logistic analyses to identify risk factors for tibial and femoral overgrowth.

Results: Femoral overgrowth occurred in 35 patients (44%). Among the 17 patients with LLD ≥ 1 cm, 13 patients (76%) showed femoral overgrowth, and the proportion of femoral overgrowth in LLD was 25% (interquartile range, 18%-31%). The distal location was identified as a risk factor for femoral overgrowth; however, for tibial overgrowth, length-stable fracture pattern, fibular involvement, operative treatment, and fracture site shortening were identified as risk factors.

Conclusions: Femoral overgrowth can occur after pediatric tibial shaft fractures; however, its contribution to the LLD was not significant. The risk factors for tibial and femoral overgrowth differed, which may be the result of different mechanisms that affect the overgrowth of the fractured tibia and the ipsilateral femur.

Keywords: Femur overgrowth; Leg length discrepancy; Pediatrics; Tibia fracture; Tibia overgrowth.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Flowchart of the study population.
See this image and copyright information in PMC

References

    1. Naik P. Remodelling in children’s fractures and limits of acceptability. Indian J Orthop. 2021;55(3):549–559. - PMC - PubMed
    1. Wilkins KE. Principles of fracture remodeling in children. Injury. 2005;36 Suppl 1:A3–A11. - PubMed
    1. Hong P, Rai S, Tang X, Liu R, Li J. External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children. J Orthop Surg Res. 2021;16(1):528. - PMC - PubMed
    1. Choi WY, Park MS, Lee KM, Choi KJ, Jung HS, Sung KH. Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture. J Orthop Traumatol. 2021;22(1):12. - PMC - PubMed
    1. Lee SH, Hong JY, Bae JH, Park JW, Park JH. Factors related to leg length discrepancy after flexible intramedullary nail fixation in pediatric lower-extremity fractures. J Pediatr Orthop B. 2015;24(3):246–250. - PubMed