Surgical indications for distal tibial epiphyseal fractures in children

The goal of this study was to investigate the treatment methods and surgical indications of distal tibial epiphyseal fractures in children. Two hundred eighty-six children with distal tibial epiphyseal fractures were included in the study. Among these patients, 202 were male and 84 were female. Mean age was 11.7 years. A retrospective study on the postoperative long-term complications and related risk factors was performed. Treatment methods were determined according to the distance of fracture displacement. A long-leg cast was applied after closed reduction for patients with primary fracture displacement less than 2 mm. For cases with more than 2 mm of fracture displacement, K-wire or screw fixation was performed. For patients with less than 2 mm of fracture displacement, closed reduction and internal fixation was performed. Open reduction was performed in patients with more than 2 mm of fracture displacement, even after closed reduction. Mean follow-up was 6.4 years. Premature physeal closure occurred in 42 patients, and, among them, varus and valgus ankle deformities occurred in 16 patients. Associated fibular fractures and cast immobilization after closed reduction for Salter-Harris type III and IV fractures were risk factors for premature physeal closure. It is not effective to determine the surgical procedure according to the distance of preoperative fracture displacement for improving the prognosis of distal tibial epiphyseal fractures in children. Conservative treatment should be performed for patients with Salter-Harris type I and II distal tibial epiphyseal fractures, and surgery should be performed in patients with Salter-Harris type III and IV distal tibial epiphyseal fractures to reduce the incidence of premature physeal closure.