Abstract
BackgroundThe treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF).MethodsWe reviewed the charts and radiographs of S-H II fractures of the distal tibia with displacement > 3 mm between 2012 and 2019 treated by ORIF. Patients were followed up for a minimum of 6 months. CT scans of injured side or contralateral ankle radiograph were obtained if there was any evidence of PPC. Any angular deformity or shortening of the involved leg was documented. Multivariable logistic regression was performed to identify risk factors for the occurrence of PPC.ResultsA total of 65 patients with a mean age of 11.8 years were included in this study. The mean initial displacement was 8.0 mm. All patients but one were treated within 7 days after injury and the mean interval was 3.7 days. Supination-external rotation injuries occurred in 50 patients, pronation-eversion external rotation in 13, and supination-plantar flexion in two. The residual gap was less than 1 mm in all patients following ORIF and all fractures healed within 4–6 weeks. Superficial skin infection developed in one patient. Ten patients complained of the cosmetic scar. The rate of PPC was 29.2% and two patients with PPC developed a varus deformity of the ankle. Patients with associated fibular fracture had 7 times greater odds of developing PPC. Age, gender, injured side, mechanism of injury, amount of initial displacement, interval from injury to surgery, or energy of injury did not significantly affect the rate of PPC.ConclusionsORIF was an effective choice of treatment for S-H II distal tibia fractures with displacement > 3 mm to obtain a satisfactory reduction. PPC is a common complication following ORIF. The presence of concomitant fibula fracture was associated with PPC.
Highlights
The treatment for displaced Salter-Harris Salter-Harris type II (II) (S-H II) distal tibia fractures remains controversial
Salter-Harris II (S-H II) distal tibia fracture carries a lower rate of growth disturbance, contributing to the fracture line being in the hypertrophic zone [4]
Barmada et al [3] reported that the incidence of premature physeal closure (PPC) will increase by 3.5-fold in presence of residual gap, and they recommended open reduction and removal of the interposed periosteum to decrease the risk of PPC
Summary
The treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF). Barmada et al [3] reported that the incidence of PPC will increase by 3.5-fold in presence of residual gap, and they recommended open reduction and removal of the interposed periosteum to decrease the risk of PPC. S-H II fractures with displacement > 3 mm were reduced no more than once at the time of injury and ORIF was undergone to remove the interposed periosteum and to decrease the iatrogenic damage to the physis. The purpose of this study sought to review the S-H II distal tibia fractures with displacement > 3 mm and to evaluate the rate of PPC treated by ORIF
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