Growth Disturbances After Distal Tibial Physeal Fractures

Abstract

Twenty-four patients with distal tibial growth disturbance were reviewed. Disturbances were classified as physeal bar (prior to deformity), angular, linear or combined deformities. Treatment consisted of osteotomy in fourteen, epiphyseodesis in seven, excision of bony bar in two, and observation in one patient. Follow up was an average 36.6 months (range 4-129 months) after treatment of growth disturbance. The age at time of injury was 10.4 years of age average (range 3-15 years). There were 12 SH2, 2 SH3, 7 SH4, and 3 SH5 distal tibial physeal fractures. Thirteen of 15 fractures considered high energy and only 1 of 9 fractures considered low energy resulted in angular deformity. Angular and linear deformities presented an average 46 months (range 12-120 months) and physeal bars at an average 14 months (range 6-25 months) after injury. Patients with a delay in presentation of growth disturbance greater than 24 months had angular deformities in 92% compared with 33% in children presenting less than or at 24 months. Treatment based on type of deformity, age at time of injury, and growth remaining was considered successful in 83%. Patients with angular or linear deformities were more likely to present late, have high energy injuries, be male patients and have Salter-Harris types IV and V. Early diagnosis and treatment of growth disturbance can prevent severe deformity.

Physeal injuries of the distal tibia: long-term results in 376 patients

“…shoe lifts, excision of the bone bridge, leg lengthening, contra and ipsilateral epiphysiodesis, corrective osteotomies [9,10].…”

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

“…Kling et al [20] described leg length discrepancies of up to 4 cm in patients who were 11 years or older at the time of injury. Furthermore, Berson and coworkers [2] found that axial deviations are more frequent, the later the growth arrest appears. In contrast, leg length differences are assumed to be equally frequent, no matter whether the growth disturbance occurs early (up to 6 months) or late after the injury.…”

Ankle and Foot Injuries in the Young Athlete

“…47 On CT, if there is > 2 mm of displacement after attempted closed reduction, operative treatment is in-dicated to avoid posttraumatic osteoarthritis or growth disturbance. 49,50 Of note, extra-articular triplane fractures do not require anatomical reduction because they do not violate the ankle joint. 49…”