Displaced Distal Tibia Physeal Fractures: Short Leg Versus Long Leg Casting-A Prospective Study
Rajvarun S Grewal1, Brock T Kitchen, James D Bomar
1Division of Orthopaedic Surgery, Rady Children's Hospital, San Deigo, CA.
Background:
The optimal treatment of distal tibia physeal fractures in pediatric patients remains controversial. Traditionally, after a closed reduction is performed, a long leg cast (LLC) is used to provide rotational control and prevent loss of reduction. Recent retrospective data suggest that short leg casts (SLC) may be equally effective. This study compares outcomes of SLC versus LLC in treating these fractures in pediatric patients.
Methods:
This prospective study enrolled patients from a pediatric level I trauma center with displaced distal tibia physeal fractures requiring reduction. Ten surgeons declared their predetermined preference for either SLC (n=5) or LLC (n=5), and patients were treated based on the on-call surgeon's preference. Inclusion criteria included patients with open growth plates and distal tibia physeal fractures. Exclusion criteria included systemic bone disease, pathologic fractures, and open fractures. Patients underwent closed reduction and were immobilized in either SLC or LLC. Follow-up assessments included clinical evaluations, radiographs, and patient-reported outcomes.
Results:
Forty patients participated, with a mean age of 12.5 years (mean follow-up of 9.4 mo). 17/40 were female. Twenty-four patients were treated with SLC and 16 with LLC. None of the fractures lost reduction. At 1 week, there were no significant differences in pain scores or satisfaction ( P >0.19). At cast removal, the LLC group reported significantly higher pain scores compared with the SLC group ( P =0.033), though satisfaction scores remained similar ( P =0.786). At the final follow-up, all outcomes of interest were comparable between the 2 groups ( P >0.09). Thirty-eight percent (15/40) of our cohort developed a premature physeal closure (PPC), 3 of which (20%) required subsequent surgery. There was no significant difference in the proportion of PPC among the SLC and LLC groups ( P =0.495).
Conclusion:
SLCs are effective in treating displaced distal tibia physeal fractures, with no increased risk of loss of reduction or premature physeal closure (PPC) compared with LLCs. Regardless of cast type, the risk of PPC is significant enough to require close follow-up.
Level Of Evidence:
Level II-prospective cohort study.
