[Late results after conservative treatment of juvenile leg fractures]

In 50 patients, who had had tibiofibular or isolated tibial fractures in childhood, we have done a clinical and radiological assessment after completion of growth. The length of both calves was compared exactly with orthoradiographic measurements. The length of the lower limbs was identical in 20 subjects and it differed by maximally two centimeters in 30 subjects, in twelve of which there was a residual deviation of the axis of five to nine degrees. From the comparison of the radiographs at the end of treatment and during the control examination it became clear that due to the continuing growth the axial deviations would decrease by maximally seven degrees in children under twelve whereas they would remain virtually constant after the age of twelve. Therefore axial deviations up to five degrees are acceptable in children under twelve years but they must be avoided after the age of twelve. Torsional dislocations must be corrected anyway. In children under twelve years lengthening occurs due to hyperemia of the epiphyseal junction. However, beyond twelve shortening of the fractured calf occurs. Therefore an initial shortening of maximally one centimeter is acceptable in children under twelve. But in older children the initial consolidation with an equal length of legs must be attempted in order to prevent a permanent difference in length after the completion of growth.