Distal Tibia Salter-Harris Fractures: To Fix or Not to Fix

It is important to review treatment considerations and provide a framework to guide decision making for nonsurgical and surgical treatment of distal tibia physeal fractures in pediatric patients. In most closed injuries, attempted closed reduction and immobilization is the initial treatment for stabilization of these fractures. Postreduction fracture alignment evaluation with a focus on residual fracture displacement at the articular surface and the physis combined with residual angulation will guide further treatment after closed reduction. Discussion of commonly occurring distal tibia physeal fracture patterns includes treatment-specific recommendations for Salter-Harris type II distal tibia fractures, medial malleolar physeal fractures, and transitional distal tibia physeal fractures including triplane fractures and Tillaux fracture patterns. Treatment recommendations include intraoperative considerations covering surgical approach, reduction techniques, and fixation options for specific fracture patterns. Surgeons should be knowledgeable about the role of skeletal maturity assessment when deciding acceptable fracture alignment, treatment strategies, follow-up, and physeal monitoring. Pertinent topics in the discussion of complications include the occurrence rate and clinical relevance of posttraumatic physeal arrest, as well as rates of further complications for specific fracture patterns and how these are influenced by surgical intervention.