Outcome of Physeal and Epiphyseal Injuries of the Distal Tibia With Intra-Articular Involvement

Abstract

The authors reviewed 83 physeal and epiphyseal injuries of the distal tibia with intra-articular involvement. The children, aged 11 to 14 years, were treated in the authors' department during 1987 to 1999. Treatment was nonoperative for 72.25% (60/83) and surgical for 27.75% (23/83) according to specific indications. This gives the basis for a classification of these injuries. The main purpose of the study was to investigate the long-term results of these injuries according to a radiologic classification. The parameters considered were the patient's age, the mechanism of injury, and the possibility of growth deformities or functional disorders. They were studied relative to the long-term results, with a follow-up of 2 to 13 years. Regardless of treatment, varus deformity, ranging from 10 to 15 degrees in relation to the normal opposite leg, occurred in four cases. In only one case was there painful limitation of ankle joint movement; in two other children an overgrowth of the medial malleolus was detected, with no functional impairment.

Prognostic factors for premature growth plate arrest as a complication of the surgical treatment of fractures of the medial malleolus in children

“…29 Long-term studies are conflicting. Whereas Caterini et al 26 identified eight of 68 patients (12%) with osteoarthritis and a statistical correlation to both initial and residual displacement in a series with a mean follow-up of 27 years, others showed no evidence of osteoarthritis at 13 and 12 years postoperatively, 27,30 in spite of displacement or growth arrest. Three of our patients with growth arrest had an irregular joint line with no correlation with the functional outcome, and we would need longer follow-up to identify the development of osteoarthritis in those patients.…”

“…13,27 Most authors, however, believe that residual displacement predisposes to growth arrest, but this has not been proved statistically. 9,10,17 Others have simply shown a trend between increased residual displacement and premature arrest.…”

Clinical and radiological results in distal tibial physeal injuries

“…Erkek çocuklarda, 10-15 yaş arası daha sık görülür ve genelde konservatif yöntemlerle tedavi edilirler. [1][2][3] Tibia alt uç büyüme plağı yaralanmaları sıklıkla supinasyon-dış rotasyon yaralanma mekanizmasıyla oluşur. İkinci sıklıkla ise pronasyon abduksiyon yaralanması şeklinde karşımıza gelir.…”

“…[6][7][8] Literatürde bu tip kırıklarda anatomik redüksiyonun mutlak olması gerektiğini bildiren yayınlar varken [10] anatomik redüksiyonun şart olmadığı-nı bildirenlerde vardır. [1][2][3][4][5][6][7][8][9][10][11] Çalışmamızda Salter-Harris tip IV yaralanmalı 13 yaşında bir çocukta büyüme plağının erken kapanmasına bağlı valgus deformitesi ve 1 cm kısalık saptandı. Olguların kısa sürede ameliyata alınması, yumuşak doku sorunlarını azaltmakta ve dolayısıyla kapalı redüksiyon manevrasıyla kırıkla-rın kolayca redükte edilmesini sağlamaktadır.…”

Die operative Behandlung von Übergangsfrakturen der distalen Tibia

“…Die kurzfristigen Ergebnisse sind in der Regel gut bis sehr gut [5,14,23]. Langzeitresultate der Übergangs-frakturen sind im Wesentlichen vom Repositionsergebnis und von der Entwicklung einer Früharthrose abhän-gig [7,8,16,21,22] …”