Does Cozen's phenomenon warrant surgical intervention?

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Traumatology

Background:

• Proximal tibial metaphyseal fractures in children can lead to complications.
• Cozen's phenomenon, a late valgus deformity, and limb elongation are potential sequelae.
• Understanding the influence of patient age on these outcomes is crucial for management.

Purpose of the Study:

• To investigate the relationship between a child's age at injury and the development of Cozen's phenomenon.
• To determine if age influences the occurrence of limb elongation following proximal tibial fractures.
• To assess the long-term resolution of valgus deformity after these pediatric fractures.

Main Methods:

• Retrospective analysis of 33 pediatric patients (6 months to 14 years) with proximal tibial metaphyseal fractures.
• Mean follow-up of 8.8 years (range: 3 to 25 years).
• Measurement of limb angulation and elongation, comparing fractured to uninjured limbs at various time points.

Main Results:

• 15 out of 33 fractures developed late valgus deformity (Cozen's phenomenon) within 8-19 months post-injury.
• 24 fractures exhibited limb elongation.
• No statistically significant association was found between patient age and the development of valgus deformity or elongation.
• Valgus deformity and limb angulation initially worsened but resolved to pre-injury levels by final follow-up.

Conclusions:

• Late valgus deformity (Cozen's phenomenon) develops in nearly half of pediatric proximal tibial fractures within two years.
• Despite initial worsening, the deformity typically corrects to the initial post-treatment angles.
• Patients and caregivers should be informed about the possibility of this deformity and its generally favorable natural resolution.