Spiral Tibia Fracture - 11 y.o. son

My son just broke his tibia this evening (first day of summer vacation nonetheless). Local hospital was not very inspiring but at least they got him in a cast to just above the knee. We are hoping to get to see an pediatric orthopedist tomorrow (as recommended by our pediatrician). First concern is whether or not surgery will be needed.

To all the internet doctors here, what are your thoughts based on these pictures?

Attachment 208220
Attachment 208221
Attachment 208222
Attachment 208223
Attachment 208224

I bet they will want to put a couple elastic nails in there, maybe a plate but probably not. It has some comminution.

No surgery yet but we are spending the night in The Hospital for Special Surgery for observation and pain management.

First cast was opened up as my son was complaining of pain. New cast goes on tomorrow morning under anesthesia. If, during that time, the dr. determines the leg isn't stable enough, they'll put in a few pins.

New cast under anesthesia this morning. Doctor was able to get leg aligned without any surgery.

Elastic nails, pins and/or a plate were all an option going in and mentioned on the consent form.

Hi! I hope your son is adjusting to life with a casted leg. My son had a similar spiral fracture to his tibia when he was 10. His x-rays looked similar to your son's. Mine was casted to nearly his groin for the first ~4 weeks, then had another 4 weeks with a cast below his knee. I wonder if yours will graduate to an air boot. I feel like those weren't used as much back then as they are now. In any case, I was, and still am amazed to consider his smooth recovery. Once the cast was off 8-9 weeks in, he didn't even require PT. It was November at that point, so he had to take the season off snowboarding, and any other speed/impact-possible sports. It took maybe 6 months for him to get back up to his pre-break running speed, but he did eventually, and it came naturally and without pressing. I hope your son's recovery will go as smoothly!

If you don't already have something long and thin, and not too scratchy, to stick into the cast for itches, find something soon. If he gets an itch, he'll greatly appreciate being able to reach it. As well, if he ends up with knee cramping from not being able to bend it, the worst of it was short lived. It seemed my son's knee hit a critical time where it was cramping hard from not being used, but then it subsided within a day or two. Best wishes for his recovery!

Best o' luck to your son. My bud's son had a similar fracture at age 9 or 10 and it healed up fine, no residual effects 10 years later.