[Post-traumatic epiphysiodesis of the distal end of the tibia in children]

Thirteen distal traumatic epiphyseal closures of the lower end of the tibia are studied. A bony bridge resection was performed in nine cases. The aim of this study was to define the kind of injury that drives to epiphysiodesis in this localisation, and secondly to define the factors that may influence the results of de-epiphysiodesis.

One hundred and eighty-eight children were hospitalized between 1981 and 1995 for the treatment of a fracture of the lower end of the tibia. Six epiphysiodesis followed a Mac Farland lesion. Six epiphysiodesis followed a Salter and Harris Type-II injury. One epiphysiodesis followed a triplane fracture. The diagnostic of epiphysiodesis was performed at an average of 12 months after injury. The bony bridge interested less than 50 per cent of the growth plate in all cases. There was a varus deformation between 7 degrees and 20 degrees in six cases (average 13.8 per cent). Ten surgical procedures were performed: one fibular bi-focal epiphysiodesis and nine tibial de-epiphysiodesis including a resection of the bony bridge filled with acrylic cement. Two children were not operated because they were close to the end of growth and there was no varus deformation. One child was not reviewed.

There was a significant correlation between the children age and the importance of the ankle varus deformation. The younger the children were and the more important the varus deformation was. Only three de-epiphysiodesis had a good clinical and radiological result. In five cases, a second surgical procedure was necessary. Fibular bi-focal epiphysiodesis gave a good clinical result.

In this location, Harris and Salter type II fractures may have a poor prognosis for growth if the injury occurred with high energy. Varus deformation is a common way to discover epiphysiodesis in this location. There was no correlation between the children age and the result of the de-epiphysiodesis, and between the delay since injury and the de-epiphysiodesis result. There was a correlation between the result and the presence of a varus dexasation in the ankle. The more important the varus was and the poorer the result was.

Mac Farland lesion and Salter and Harris type II lesion drive to epiphysiodesis more often than any other distal tibial fracture. Varus desaxation is more important in younger children and seems to determine de-epiphysiodesis results. But over all, de-epiphysiodesis has a poor prognosis in more than 60 per cent of cases.