Foot progression angle after distal tibial physeal fractures

Twenty-three patients with Salter 1 or 2 fractures of the distal tibia had follow-up with footprints to assess rotational deformities. Fourteen had external rotation deformity >+2 SD of the normal mean of 5 degrees to 6 degrees. Eight of the 14 had the finding of physeal widening of 2 mm or more. The widening was most commonly wedge-shaped and based anteriorly. The mean foot progression angle of the fractured sides was externally rotated 14 degrees, and the mean foot progression angle of the uninjured sides was externally rotated 10 degrees; both exceeded the normal mean. The fractured side mean was significantly more externally rotated than the uninjured side mean. Preexisting external rotation deformity may be a risk factor for these fractures. Closed reduction with long leg bent-knee casting is justified in more than half of these patients.