Physeal fractures of the lower leg in children and adolescents: Therapeutic results, pitfalls and suggested management protocol - based on the experience of the authors and contemporary literature

Abstract

PurposePhyseal fractures in children frequently give rise to concerns about the condition of the growth plate. Our observations have proven that the dysfunction of the growth plate is less frequent complication in those cases than misdiagnosed interposition of the periosteum. The aim of this paper is to familiarize the readers with the issue of treatment of physeal fractures of the distal tibia and fibula in the growing skeleton. Materials and methodsWe analyzed the group of 75 patients – children and adolescents – with surgically treated physeal fractures of the lower leg. The analysis included age, sex, circumstances of trauma infliction, type of sustained damage, employed therapeutic technique, timing of surgical procedure, duration of hospitalization, complications, duration of follow-up, radiological and functional results according to the AOFAS scale. ResultsThe group consisted of 23 girls and 52 boys. The mean age was 13.6 years. The most frequent cause of trauma was same-level fall, usually during sports activities (35 cases). The most common type of damage was Salter-Harris type II fracture (35 cases). Among the employed surgical techniques, open reduction and stabilization with K-wires was the most often used (52 cases). A group of four patients attracted our attention, in whom after a closed reduction, signs of periosteum interposition were noted. These patients required a second procedure. In one patient, the growth plate arrest occurred; it was directly caused by local osteomyelitis. ConclusionsWith adequately conducted treatment of distal tibia and distal fibula physeal fractures, the results are good. Misdiagnosed periosteum interposition poses a more serious clinical problem as opposed to the commonly anxiety-provoking post-traumatic growth plate dysfunction.