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Does Cozen's phenomenon warrant surgical intervention?

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Children with proximal tibial fractures may develop late valgus deformity (Cozen's phenomenon) and limb elongation. This deformity often resolves naturally, regardless of the child's age at injury.

Keywords:
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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.