Distal Tibia In Children Research Articles

Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents.

. This study performed to investigate the incidence of growth arrest such as leg length discrepancy (LLD) and ankle joint angular deformity and its risk factors after physeal fracture of the distal tibia in children and adolescents. . Consecutive 78 patients (mean age 11.4 ± 2.0 years; mean follow-up period 2.0 ± 1.2 years) treated for the distal tibia physeal fracture were included. All patients underwent preoperative ankle radiographs, three-dimensional computed tomography (CT) scans, and postoperative follow-up teleradiogram. Patients were divided into two groups according to the LLD and the difference of lateral distal tibial angle (LDTA) with the contralateral limb as follows: Group 1 (growth arrest), patients with LLD ≥ 1cm or difference of LDTA ≥ 5°; Group 2 (normal growth), patients with LLD < 1cm and difference of LDTA < 5°. . The overall incidence of growth arrest was 12.8% (10 of 78). The mean displacement measured using CT scan was 4.4 ± 3.2 mm (range, 0.8-14.9). Of the total 78 fractures, 65 were treated surgically and 13 fractures were treated conservatively. The initial fracture displacement was significantly different between the two groups (p<0.001). However, there were no statistically significant differences between the two groups with respect to other factors. Initial displacement was the only significant risk factor for growth arrest (p<0.003). The cutoff values of initial displacement between the two groups were 5.2mm. . This study showed that degree of initial displacement was the only significant risk factor for growth arrest after physeal fracture of the distal tibia in children and adolescents. Therefore, physicians should consider the possibility of growth arrest for patients with severely displaced physeal fractures of the distal tibia.

Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children

Background and purpose — Unnecessary radiographic and clinical follow-ups are common in treatment of pediatric fractures. We hypothesized that follow-up radiographs are unnecessary to monitor union of physeal fractures of the distal tibia.Patients and methods — All 224 (147 boys) children under 16 years old treated for a physeal fracture of the distal tibia during a 5-year period (2010–14) in Helsinki Children’s Hospital were included in this study. Peterson type II fractures comprised 55% and transitional fractures (Tillaux and Triplane) 20% of all injuries. Fracture displacement and alignment was measured. Type and place of treatment was recorded. Number of follow-up radiographs and outpatient visits was calculated and their clinical significance was assessed.Results — 109 children had fractures with < 2 mm displacement and no angulation. The other 115 children’s mean fracture displacement was 6 mm (2–28). 54% of all children were treated by casting in situ in the emergency room, 20% with manipulation under anesthesia and 26% with surgery (internal 57, external fixation 2). Median 3 (1–7) follow-up appointments and median 3 (0–6) radiographs were taken. Follow-up radiographs at or before cast removal did not alter treatment in any of the patients. 223 patients’ fractures healed within 4–9 weeks in good alignment (≤ 5° angulation).Interpretation — Routine radiographic follow-up is unnecessary to monitor alignment and union of physeal fractures of the distal tibia.

Triplane Fractures of the Distal Tibia in Children

To review 28 cases of paediatric triplane fractures of the distal tibia over a 7-year period in a tertiary paediatric hospital. Records of 21 boys and 7 girls aged 11 to 15 (mean, 13) years presented with triplane fractures of the left (n=14) and right (n=14) ankles were retrospectively reviewed. Injury mechanism included low-energy trauma (n=10) and moderate-energy trauma (n=18). Fractures were 2-part in 20 patients, 3-part in 6, and 4-part in 2. 11 patients had concomitant fibular fractures. Articular displacement was <2 mm in 17 patients and ≥2 mm in 11 patients. 17 patients were treated conservatively (cast immobilisation); 11 were treated surgically by closed reduction and percutaneous pinning (n=1), open reduction and percutaneous pinning (n=5), closed reduction and internal fixation (n=3), or open reduction and internal fixation (n=2). Transepiphyseal partially threaded cannulated screws were used for fixation. The mean period of casting was 5.8 weeks, and the mean non- weight bearing period was 6.1 weeks. The mean follow-up period was 14.2 (range, 9-20) weeks. All patients had excellent outcome. No patient had any infections, delayed or non-union. Six patients had decreased range of motion and 4 had pain 4 weeks after cast removal. Treatment outcome of triplane fractures of the distal tibia in children is good when guidelines are closely adhered to.

Cortical porosity is higher in boys compared with girls at the distal radius and distal tibia during pubertal growth: An HR-pQCT study

The aim of this study was to determine the sex- and maturity-related differences in bone microstructure and estimated bone strength at the distal radius and distal tibia in children and adolescents. We used high-resolution pQCT to measure standard morphological parameters in addition to cortical porosity (Ct.Po) and estimated bone strength by finite element analysis. Participants ranged in age from 9 to 22 years (n = 212 girls and n = 186 boys) who were scanned annually for either one (11%) or two (89%) years at the radius and for one (15%), two (39%), or three (46%) years at the tibia. Participants were grouped by the method of Tanner into prepubertal, early pubertal, peripubertal, and postpubertal groups. At the radius, peri- and postpubertal girls had higher cortical density (Ct.BMD; 9.4% and 7.4%, respectively) and lower Ct.Po (-118% and -56%, respectively) compared with peri- and postpubertal boys (all p < 0.001). Peri- and postpubertal boys had higher trabecular bone volume ratios (p < 0.001) and larger cortical cross-sectional areas (p < 0.05, p < 0.001) when compared with girls. Based upon the load-to-strength ratio (failure load/estimated fall force), boys had lower risk of fracture than girls at every stage except during early puberty. Trends at the tibia were similar to the radius with differences between boys and girls in Ct.Po (p < 0.01) and failure load (p < 0.01) at early puberty. Across pubertal groups, within sex, the most mature girls and boys had higher Ct.BMD and lower Ct.Po than their less mature peers (prepuberty) at both the radius and tibia. Girls in early, peri-, and postpubertal groups and boys in peri- and postpubertal groups had higher estimates of bone strength compared with their same-sex prepubertal peers (p < 0.001). These results provide insight into the sex- and maturity-related differences in bone microstructure and estimated bone strength.

Manipulative reduction and percutaneous cannulated screws fixation for triplane fractures of the distal tibia in children

Objective To evaluate the result of manipulative reduction and percutaneous cannulated screws fixation for the triplane fracture of the distal tibia in children. Methods From September 2004 to March 2009, 15 cases of triplane fracture of the distal tibia were treated with manipulative reduction and percutaneous cannulated screws fixation. This study included 9 boys with an average age of 13.2 years (range, 12-14 years) and 6 girls with an average age of 12.4 years (range, 11-14 years). Preoperative diagnoses were confirmed by the X-ray films or CT examination. If plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm after closed reduction, the operation was needed. Under C-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous cannulated screw. Postoperative CT scanning confirmed anatomical reduction. All patients had been immobilized with cast for 8 weeks. The ankle joint function and growth were evaluated by modified Weber protocol. Results All patients were followed up for 15 to 68 months with an average of 26 months. There were excellent in 13 cases, good in 2 cases. X-ray films showed all fractures were healed. There were not bone bridge and uneven articular surface, or rotating and shortening deformity. All patients could participate in the normal physical activities. The 2 cases with good outcome were related to weight-bearing too early. The main problem was that pain occurred in ankle joint with excess activity. Conclusion The method of manipulative reduction and percutaneous cannulated screw fixation is relatively reliable treatment for closed triplane fractures of the distal tibia. Key words: Tibial fracture; Treatment outcome; Epiphyses; Child

Site Specificity of Bone Architecture Between the Distal Radius and Distal Tibia in Children and Adolescents: An HR-pQCT Study

High-resolution quantitative computerized tomography permits evaluation of site specific differences in bone architecture. The purpose of this study was to compare bone architecture between distal radius and distal tibia. We present bone architecture at the distal radius and distal tibia in 151 male and 172 female participants, as follows: total bone area (mm(2)), total bone density (mgHA/cm(3)), trabecular bone density (mg HA/cm(3)), cortical bone density (mg HA/cm(3)), cortical thickness (μm), trabecular number (1/mm), trabecular thickness (μm), and trabecular separation (μm). We evaluated differences in and correlations between bone variables (absolute values) across sites. We calculated individual z scores and used regression to assess discordance between sites. In pubertal and postpubertal male and female participants, absolute values of total bone area, cortical bone density, cortical thickness, and trabecular thickness were significantly lower at the radius compared with the tibia (P<0.01). Absolute values for trabecular bone density were significantly lower at the radius compared with the tibia in postpubertal male and female participants (P<0.01). Absolute values for trabecular separation was significantly lower at the radius compared with the tibia in pubertal female participants (P<0.01). Bone architecture was moderately to highly correlated between sites (r=0.34-0.85). There was discordance between z scores at the radius and tibia within male participants (pubertal R (2) between 36 and 64%; postpubertal R (2) between 22 and 77%) and female participants (pubertal R (2) between 10 and 44%; postpubertal R (2) between 25 and 62%). In conclusion, it is vital to evaluate bone architecture at the specific skeletal site of interest.

Resection Arthrodesis of the Ankle for Aggressive Tumors of the Distal Tibia in Children

There is no consensus on the ideal treatment for malignant tumors of the distal tibia. Many favor amputation. Thirteen children, at an average age of 12 years (8 to 16 y) sustained conservative surgical treatment for a tumor of the distal tibia. All patients had "en bloc" resection of the tumor with ankle arthrodesis achieved by nail or plate accompanied by autograft. The results were assessed retrospectively with an average follow-up of 8.8 years. Nine patients were in complete remission. Two patients had died. Two patients were lost to follow-up. Two patients had a local recurrence, which required amputation. There were 4 infections, which responded well to therapy. Four patients required additional bone grafting because of nonunion. Three patients required osteotomy for malalignment. Bone healing was achieved for the 9 patients seen at last follow-up. All were able to walk with an average functional score of 24.7/30 (23 to 26) on the Musculoskeletal Tumor Society score. Several reconstructive techniques are available: mega prosthesis of distal tibia and ankle, reconstruction by vascularized fibula or by autograft. All series reported significant rates of infections, cutaneous necrosis, and nonunion. Conservative treatment with ankle arthrodesis is a possible alternative to amputation for the management of malignant tumors of the distal tibia in selected patients. Survival results and functional outcome were good despite initial complications. This is a retrospectively therapeutic study graded level 2 as level of evidence.

Should Toddler's Fracture Be Renamed?

Isolated spiral fractures of the distal tibia in children are better known to emergency physicians as toddler's fractures. According to these authors, the original definition of toddler's fracture (a nondisplaced, radiologically obscure fracture involving the distal third of the tibia in a child 9 to 36 months old) is inconsistent …

けい骨遠位骨端線損傷の経皮的固定による治療

Eleven cases with epiphyseal injuries of the distal tibia in children were treated by percutaneous pin fixation. In all cases, satisfactory results were obtained without deformity and growth disturbance of the ankle. Percutaneous pin was fixation was an easy and effective treatment for epiphyseal injuries of the distal tibia which required closed reduction.

Direct reduction with indirect fixation of distal tibial physeal fractures: a report of a technique.

Displaced intraarticular fractures of the distal tibia in children often require open reduction and internal fixation. Displaced epiphyseal fractures in the sagittal plane may be difficult directly to visualize from a standard medial malleolar incision, so accurate reduction may be impossible. Approaching the ankle joint by anterior arthrotomy, the fracture line can be directly visualized and accurately manipulated and reduced. However, access to the medial malleolus for insertion of internal fixation devices may be difficult from an anterior incision. We have found that after anterior arthrotomy and open reduction, rigid fixation can be placed percutaneously from medially or, in exceptional cases, from laterally under fluoroscopic control. The physis and talocrural joint can be seen and avoided in the growing child. Thirteen cases fixed by this method are reported. At 12.2-month average follow-up, clinical results were excellent. There were no instances of joint degenerative changes but one growth derangement.

Direct Reduction with Indirect Fixation of Distal Tibial Physeal Fractures: A Report of a Technique

Summary Displaced intraarticular fractures of the distal tibia in children often require open reduction and internal fixation. Displaced epiphyseal fractures in the sagittal plane may be difficult directly to visualize from a standard medial malleolar incision, so accurate reduction may be impossible. Approaching the ankle joint by anterior arthrotomy, the fracture line can be directly visualized and accurately manipulated and reduced. However, access to the medial malleolus for insertion of internal fixation devices may be difficult from an anterior incision. We have found that after anterior arthrotomy and open reduction, rigid fixation can be placed percutaneously from medially or, in exceptional cases, from laterally under fluoroscopic control. The physis and talocrural joint can be seen and avoided in the growing child. Thirteen cases fixed by this method are reported. At 12.2-month average follow-up, clinical results were excellent. There were no instances of joint degenerative changes but one growth derangement.

Techniques of open reduction internal fixation of Salter-Harris type II, III, and IV fractures of the distal tibia in children

Salter-Harris type II, III, and IV fractures of the distal tibia are common and have a propensity to developpremature physeal closure. Parents should be advised of this potential occurrence and its implications. Management of these fractures is directed at reducing this complication.