The Journal of Bone and Joint Surgery, Vol 66, Issue 5 647-657, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Distal tibial physeal fractures in children that may require open reduction
TF Kling, RW Bright and RN Hensinger
Fractures of the distal end of the tibia in children often involve the
physis. They are of particular importance because partial growth arrest can
occur and result in angular deformity, limb-length discrepancy, or
incongruity of the joint surface (or a combination of these). We evaluated
the cases of thirty-two children who had a fracture leading to established
partial growth arrest of the distal end of the tibia. Most of this group
had had a Salter-Harris Type-III or Type-IV fracture. Twenty-eight of the
fractures had been treated by gentle closed reduction and immobilization in
a plaster cast. We also evaluated the cases of thirty-three children who
were seen by us for treatment of an acute fracture; most of these were
Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia.
Nineteen of the twenty acute Type-III or Type-IV fractures that were
treated with accurate open reduction of the physis and internal fixation
healed without growth disturbance, while five of the nine fractures that
were treated by closed means formed a bone bridge, presaging a disturbance
in growth. This study suggests that Salter-Harris Type-III and Type-IV, and
perhaps Type-II, fractures of the distal end of the tibia commonly cause
disturbance of growth in the tibia, and that anatomical reduction of the
physis by closed or open means may decrease the incidence of these
disturbances of growth, including shortening and varus angulation of the
ankle.
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