Distal Tibial Physeal Injuries in Children

Dugan, G.; Herndon, William A.; McGuire, Robert A.

doi:10.1097/00005131-198701010-00010

Cited by 39 publications

(20 citation statements)

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“…Although Dugan et al. ( 1987 ) considered SH II distal tibial fractures to be low-risk fractures based on the rate of complications (2–5%), we believe that displaced SH II distal tibial fractures should be considered high-risk fractures based on the incidence of PPC.…”

Section: Discussionmentioning

confidence: 73%

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What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

et al. 2017

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Background and purposeThe optimal treatment of displaced Salter–Harris (SH) II fractures of the distal tibia is controversial. We compared the outcomes of operative and nonoperative treatment of SH II distal tibial fractures with residual gap of >3 mm. Factors that may be associated with the incidence of premature physeal closure (PPC) were analyzed.Patients and methodsWe retrospectively reviewed 95 patients who were treated for SH II distal tibial fractures with residual gap of >3 mm after closed reduction. Patients were assigned to 1 of 2 groups: Group 1 included 25 patients with nonoperative treatment, irrespective of size of residual gap (patients treated primarily at other hospitals). Group 2 included 70 patients with operative treatment. All patients were followed for ≥ 12 months after surgery, with a mean follow-up time of 21 months. Logistic regression analyses were performed to identify risk factors for the occurrence of PPC.ResultsThe incidence of PPC in patients who received nonoperative treatment was 13/52, whereas PPC incidence in patients who received operative treatment was 24/70 (p = 0.1). Multivariable logistic regression analysis determined that significant risk factors for the occurrence of PPC were age at injury, and injury mechanism. The method of treatment, sex, presence of fibular fracture, residual displacement after closed reduction, and implant type were not predictive factors for the occurrence of PPC.InterpretationOperative treatment for displaced SH II distal tibial fractures did not seem to reduce the incidence of PPC compared with nonoperative treatment. We cannot exclude that surgery may be of value in younger children with pronation–abduction or pronation–external rotation injuries.

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Section: Discussionmentioning

confidence: 73%

“…SH II fractures are considered low-risk fractures because the incidence of premature physeal closure (PPC) was reported as 2–5% in a previous study (Dugan et al. 1987 ). However, some studies indicate that PPC may be more common than previously realized in specifically SH II distal tibial fractures (Spiegel et al.…”

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confidence: 99%

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

et al. 2017

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“…Reports on their incidence vary from 5 to 15% [21,32,33,38]. Similar rates are mentioned in older investigations [5,11,20,34]. This clearly contrasts with the results of more current studies, in which percentages of between 36 and 39 % have been reported [1,30].…”

Section: Restrictive Growth Disturbances: Incidence and Consequencesmentioning

confidence: 57%

“…In the standard literature the consequences of growth disturbances are described as not serious in most cases, due to the advanced age of the patients who are nearing the physiological closure of the physeal plate [17,21,32]. Several studies arrived at similar results [6,11,24,26]. However, other authors and working groups had different perceptions: Spiegel et al [34] found leg length discrepancies requiring orthopedic or surgical therapy in 3.6 % of SH I injuries and 13.6% of SH II injuries.…”

Section: Restrictive Growth Disturbances: Incidence and Consequencesmentioning

confidence: 99%

“…Most investigations recommend conservative treatment of SH I and II fractures of the distal tibia; in cases with an unacceptable primary displacement, they prefer a closed reduction under general anesthesia [3,11,14,19,23], as do the textbooks on pediatric trauma [7,21,33,38]. In the standard literature we also find comments on tolerable posttraumatic axial deviations and displacements.…”

Section: Mode Of Therapy and Growth Disturbancesmentioning

confidence: 99%

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Growth Disturbances of the Distal Tibia after Physeal Separation – What Do We Know, What Do We Believe We Know? A Review of Current Literature

Kraus

Kaiser

2008

Eur J Pediatr Surg

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There are two major deficiencies in most of the reviewed literature. The first is that the numbers of cases reported in each article are low due to the rarity of the injury. The second deficiency is that many studies report "physeal injuries" but do not clearly distinguish physeal separations (Salter I and II) from epiphyseal fractures (Salter III and IV) and transitional fractures, all involving the physeal plate, but in completely different ways with completely different prognoses. A prospective multicenter study is taking place.

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Tibia and Fibula

2000

Skeletal Injury in the Child

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Distal Tibial Physeal Injuries in Children

Cited by 39 publications

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What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

Growth Disturbances of the Distal Tibia after Physeal Separation – What Do We Know, What Do We Believe We Know? A Review of Current Literature

Tibia and Fibula

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