Outcome of distal tibial physeal injuries

In a retrospective review of 725 children's tibial fractures between 1990 and 2004, we found paediatric tibial fractures to have a bimodal distribution according to age, peaking at the age 14 years with incidence of 17.1 in 1000 in boys and 5.1 in 1000 in girls. Two hundred and twenty-five (31.0%) cases involved the distal tibial physis, associated with Salter-Harris (SH) I (0.4%), SH II (56.9%), SH III (21.7%) and SH IV (20%) injury patterns. Of these fractures, 77% had initial displacement of more than 2 mm and independent of treatment modality, 20% of cases still had residual displacement of more than 2 mm after reduction. There was significantly less residual displacement in patients who had a computed tomography scan before the intervention versus those who did not (0.3 vs. 1.4 mm, P=0.003). Twelve cases (11.2%) of premature physeal closure were identified after SH II (67%), SH III (17%) and SH IV (17%) fractures. No significant link was found between premature physeal closure and displacement (either initial or residual), mechanism of injury, or treatment modality. In those fractures with an intact fibula, we found significantly less initial displacement (4.7 vs. 7.4 mm, P<0.05) and significantly shorter time to union (6.27 vs. 7.55 weeks, P=0.001). Good anatomical reduction with or without open reduction and internal fixation is one of the important factors in reducing complication rates, and we suggest but cannot statistically prove that open reduction and internal fixation is indicated in fractures with a residual displacement of 2 mm or more. The presence of an intact fibula at the time of tibial fracture has a significant positive influence on fracture outcome. Level III: Retrospective Review.