Reviewing Current Concepts in Distal Tibial Physeal Injuries: New Twists and Old Turns?

Abstract

Distal tibial physeal injuries are common in children accounting for a significant proportion of the paediatric trauma. They are commonest between the years of 10-16, temporally related to the timing of physeal closure. They are strongly associated with sporting activities where there are significant sudden changes in direction with resulting force applied through the distal physis. This article reviews the anatomy, pathophysiology, imaging, classification systems and management of these injuries. Salter Harris, Tillaux and triplanar fractures are discussed. This article, in addition to informing the reader of the above, we hope will also update the reader of relevant new twists in management strategy as well as re-visit the old turns that have provided the main stay of orthopaedic surgical understanding of these injuries.

Displaced distal tibial Salter-Harris II fractures

“…Fractures of the distal tibial physis are estimated to account for up to 40% of all physeal injuries in children. [1][2][3] The Salter-Harris II (SHII) 4 fracture is the most common type of physeal injury in the tibia, accounting for over 50% of distal tibial physeal injuries. 2,5 The mean age of these injuries is 12.5 years, and almost all occur in patients aged over eight years.…”