Below-Knee Cast Immobilization for Distal Tibial Physeal Fractures

Distal tibial physeal injuries are one of the most commonly reported fractures in children. Traditionally, treatment recommendations consist of utilization of a long leg cast for initial immobilization. The purpose of this study was to evaluate the efficacy of below-knee cast immobilization in the closed treatment of distal tibial physeal fractures. We reviewed all patients with distal tibial physeal fractures treated with below-knee immobilization at our tertiary care facility between January 2002 and September 2015. Radiographs were analyzed for displacement and angulation at the time of injury, after closed reduction and/or casting, and at completion of immobilization to evaluate for loss of reduction. In total, 120 fractures (120 patients) were reviewed with 63 (52.5%) extra-articular fractures and 57 (47.5%) intra-articular fractures. The mean initial displacement was 4 mm (range 0-26 mm) with 34 patients having greater than 2 mm of displacement at presentation. Closed reduction was performed on 33 (27.5%) patients with the remaining 87 (72.5%) receiving immobilization alone without formal reduction. All fractures successfully healed with only 2 (1.67%) patients experiencing a loss of reduction. Both patients that lost reduction had undergone an initial closed reduction. No nondisplaced fractures lost reduction. These findings suggest that below-knee immobilization is an effective alternative in the treatment of both nondisplaced and displaced distal tibial physeal fractures, including those with intra-articular involvement, as well as those undergoing closed reduction. This creates an opportunity to provide increased patient mobility and early knee range of motion.