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Clinical Pathways promote evidence-based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by a methodical review of available evidence and consensus among committee members.   

Clinical Pathways:

Inclusion and exclusion criteria


  • Patients aged 1 to 4 years.
  • Stable tibial shaft or distal tibia fracture, defined as:  
    • No cortical displacement. 
    • No fracture shortening. 
    • No angulation.
    • No malrotation.  
    • Intact fibula.
    • Can be spiral or buckle fracture pattern.


  • Patients with multisystem trauma.
  • High energy mechanism.
  • Infection.
  • Neoplasm.  
  • Non-accidental trauma.  
  • Non-ambulatory.
  • Multiple fractures.  
  • Metabolic bone disease.  
  • Any amount of cortical displacement.
  • Any amount of fracture shortening.
  • Any amount of angulation.
  • Reduction required.
  • Associated fibula fracture.

Committee members involved in the development: 

  • M. Sinclair, MD | Orthopedic Surgery | Committee chair 
  • C. Grote, MD, PhD | Orthopedic Surgery | Committee Member  
  • P. D. Souza, MD| Urgent Care | Committee Member  
  • L. Patel, MD | Emergency Department | Committee Member  
  • A. Patel, MD, FAAP | Emergency Department | Committee Member  
  • E. Weber, MD | General Academic Pediatrics | Committee Member  
  • B. Haney, BSN, RN, CWCN, WTA-C | Wound Care | Committee Member  
  • T. Glenski, MD, MSHA, FASA | Department of Evidence Based Practice | Committee Member 
  • J. Dusin, MS, RD, LD, CPHQ | Department of Evidence Based Practice | Committee Member 

Publication dates: 

  • Finalized date: May 2022 
  • Next expected revision date: May 2025 

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These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.