Traumatic growth arrest of the distal tibia: a clinical and radiographic review

Injury to the physis of the distal tibia in children can lead to subsequent growth arrest. This can result in physeal bars, leg-length discrepancies and angular deformities.

The cases of 12 children with distal tibial growth arrest due to ankle trauma were reviewed. All were treated at a tertiary care institution between 1990 and 2002.

The average age at initial injury was 9.7 years (range 5-13 yr). Salter-Harris classifications (SH) of their injuries were SH2 in 4 children, SH3 in 1, SH4 in 6 and SH5 in 1 child. Four involved open fractures; 5 were high-energy injuries. Six of the injuries resulted in simple physeal bars, 4 caused pure angular deformities and 2 resulted in leg-length discrepancies > 2 cm. Eight of the physeal arrests were treated either with bar excision, selective epiphysiodesis or osteotomy for angular correction.

This series reinforces the importance of frequent follow-up of distal tibial physeal injuries in order to detect growth arrest early, thus facilitating corrective surgery.