Transitional fractures of the distal tibia

The purpose of the study was to determine the outcome after treatment of transitional fractures of the distal tibia, including growth disturbances, osteoarthritis, and/or restriction of the ability to take part in sports.

In a retrospective multicentre study of 72 patients, 50 were evaluated by clinical and 46 by radiographic examination, an average of 7.4 years (standard deviation 5.9) after treatment. Of these 50 patients, initially 20 were treated non-operatively and 30 were treated operatively. The mechanism was mainly supination trauma.

There were four revision operations, including two for fracture displacement after earlier non-operative treatment. No patients reported impairment of sports activities. In no case was the range of movement in the upper ankle joint decreased by >10 degrees . Radiographic examination revealed small osteophytes in one case and narrowing of the joint space in two; there was no axial deviation or clinical problems in any of these cases. There were no significant differences between the group treated non-operatively and the group that underwent surgery. The intermediate- to long-term outcome presented was good or very good in both the surgically and conservatively treated patients. Only two of the initially nondisplaced fractures later became displaced. This finding emphasises that operative treatment is not indicated for all nondisplaced fractures. Axial deviations may not occur, because of the little growth potential of the partially closed physis.