Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents

The incidence of physeal fractures in the lower limb and the frequency of premature physeal closure: a cohort study of 236 patients

“…126 (53%) of the children were boys and the median age was 12 (range 2-15) years for boys and 10.5 (2-15) years for girls (Mann-Whitney test, p = 0.1) (Table 1). The median age was 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) for physeal fractures in the distal femur, 9 (2-15) years for the proximal tibia, 12 (3-15) years for the distal tibia, and 10.5 (2-15) years for the distal fibula. Falls from above ground level were the most frequent cause of injury (32%) followed by sports (31%), transport-related injuries (19%), and falls from ground level (18%).…”

“…The overall prevalence of PPC was 9.7% (CI 6. [3][4][5][6][7][8][9][10][11][12][13][14], while the prevalence was 38% (CI 8.5-76) for distal femur, 15% (CI 5.9-31) for proximal tibia, 14% (CI 7.4--22) for distal tibia, and 1.1% (CI 0.3--59) for distal fibula. We found a significant higher hazard of PPC in fractures with ≥ 3 mm displacement (hazard ratio: 12, CI 1.5-97).…”

“…Between 15% and 20% of all pediatric fractures involve the physeal growth plates [4,5]. Physeal fractures may be associated with complications such as premature physeal closure (PPC) that can lead to limb-length discrepancy (LLD), and/or angular deformity (AD) [6][7][8][9][10][11].…”

“…PPC occurs most often after physeal fractures in the lower limbs, most frequently in the distal tibia, distal femur, and proximal tibia [3,12]. Studies have reported that PPC occurs in 12-15% of all physeal fractures in the distal tibia, 26-64% of physeal fractures in the distal femur, and 10-45% of the physeal fractures in the proximal tibia [6,7,[9][10][11][13][14][15][16]. However, most studies have had small patient numbers or were case studies.…”

Value of growth arrest lines for predicting treatment effect on children with distal tibial epiphysis fractures

“…Moreover, the growth arrest line was observed in most patients with epiphyseal development grades 0 and 1. One previous study in children and adolescents found that the degree of initial displacement was the only significant risk factor for growth arrest after an epiphyseal fracture of the distal tibia ( 10 ). However, initial displacement cannot be used to evaluate treatment results.…”