Tibial Shaft Fractures‣Mx = Non op vs OpNon op with full cast‣Relative indications for surgery?Relative indications for op = segmental, floating knees, open #, large obese children, poor alignment‣Surgical technique?TENS Nail + Back slab ➔ Convert to cast in clinic‣Is there weight limitation for Tibia flexible nail like femur nail?NoGoodbody et al. 2015 found no sig difference between weight >50kg (as compared to femur shaft) for titanium nailsToddler’s Fracture‣What is toddler fracture?Spiral # of tibial In young ambulatory children (1-4 years old)‣What is the common MOI?MOI: Seemingly harmless twist or fall‣What fracture configuration may make you suspect NAI?Transverse tibial # suspect NAI! And less than 1 year non ambulatory child‣Clinical presentation?Refusal to wt bear, walk with limp (Do not diagnosis transient synovitis till > 4 years old)‣Management?Immobilised in above knee cast for 3/52