Physeal Fractures of the Distal Tibia and Fibula (Salter-Harris Type I, II, III, and IV Fractures)

Podeszwa, David A.; Mubarak, Scott J.

doi:10.1097/bpo.0b013e318254c7e5

Cited by 56 publications

(34 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A clinically presumed SH1DF presented with all of the following criteria: (1) limited weight bearing, (2) tenderness and swelling over the lateral aspect of the distal fibula at the level of the physis, and (3) 3 radiographic views of the ankle demonstrating open physes and the absence of a fracture. [5][6][7][8] Excluded were children with injuries greater than 3 days old, preexisting musculoskeletal or coagulopathic disease, developmental delay, history of ankle fracture within 3 months, and families with an insurmountable language barrier and/or no telephone access. The study was approved by the human ethics review boards at the Hospital for Sick Children and the Children's Hospital of Eastern Ontario.…”

Section: Study Populationmentioning

confidence: 99%

Radiograph-Negative Lateral Ankle Injuries in Children

et al. 2016

View full text Add to dashboard Cite

IMPORTANCE Lateral ankle injuries without radiographic evidence of a fracture are a common pediatric injury. These children are often presumed to have a Salter-Harris type I fracture of the distal fibula (SH1DF) and managed with immobilization and orthopedic follow-up. However, previous small studies suggest that these injuries may represent ankle sprains rather than growth plate fractures. OBJECTIVES To determine the frequency of SH1DF using magnetic resonance imaging (MRI) and compare the functional recovery of children with fractures identified by MRI vs those with isolated ligament injuries. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted between September 2012 and August 2014 at 2 tertiary care pediatric emergency departments. We screened 271 skeletally immature children aged 5 to 12 years with a clinically suspected SH1DF; 170 were eligible and 140 consented to participate. INTERVENTIONS Children underwent MRI of both ankles within 1 week of injury. Children were managed with a removable brace and allowed to return to activities as tolerated. MAIN OUTCOMES AND MEASURES The proportion with MRI-confirmed SH1DF. A secondary outcome included the Activity Scale for Kids score at 1 month. RESULTS Of the 135 children who underwent ankle MRI, 4 (3.0%; 95% CI, 0.1%-5.9%) demonstrated MRI-confirmed SH1DF, and 2 of these were partial growth plate injuries. Also, 108 children (80.0%) had ligament injuries and 27 (22.0%) had isolated bone contusions. Of the 108 ligament injuries, 73 (67.6%) were intermediate to high-grade injuries, 38 of which were associated with radiographically occult fibular avulsion fractures. At 1 month, the mean (SD) Activity Scale for Kids score of children with MRI-detected fibular fractures (82.0% [17.2%]) was not significantly different from those without fractures (85.8% [12.5%]) (mean difference, −3.8%; 95% CI, −1.7% to 9.2%). CONCLUSIONS AND RELEVANCE Salter-Harris I fractures of the distal fibula are rare in children with radiograph fracture-negative lateral ankle injuries. These children most commonly have ligament injuries (sprains), sometimes associated with radiographically occult avulsion fractures. Children with fractures detectable only by MRI had a comparable recovery with those with sprains when treated with a removable ankle brace and self-regulated return to activities. This work has the potential to simplify the care of these common injuries, safely minimizing the inconveniences and costs of overtreatment.

show abstract

Section: Study Populationmentioning

confidence: 99%

Radiograph-Negative Lateral Ankle Injuries in Children

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Percutaneous screws have been used for the fixation of epiphyseal ankle fractures in many studies in the literature (Podeszwa et al 2008; Castellani et al 2009; Sankar et al 2013; Charlton et al 2005; Podeszwa and Mubarak 2012). Lintecum and Blaiser have reported good clinical results after using percutaneous cannulated screws (Lintecum and Blasier 1996).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous cannulated screw fixation for pediatric epiphyseal ankle fractures

et al. 2016

View full text Add to dashboard Cite

BackgroundAnkle injuries are among the most common injuries in children. The aim of this study was to compare the efficacies of two percutaneous fixation methods after closed reduction in physeal ankle fractures.MethodsWe reviewed the cases of 24 patients with a mean age of 12.29 years; 16 were male, and 8 were female. Only patients with fractures of Salter-Harris types 2, 3, and 4 with displacements greater than 2 mm were included in the study. Patients were treated with closed reduction manipulation and percutaneous screw fixation. For each patient, either cannulated or headless full threaded compressive screws were used for percutaneous fixation. Radiological and clinical healing time, range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and physeal arrest were then measured.ResultsThe mean follow-up time was 13 months. The mean time until cast removal was 3.5 weeks (range 2–5). A full ROM was achieved at an average of 5.7 weeks postoperatively (range 4–8). The radiologic healing time was 6.1 weeks (range 4–7). The patients’ clinical healing time averaged 6.8 weeks (range 5–8). Differences in radiologic healing time (p = 0.487), clinical healing time (p = 0.192), AOFAS score (p = 0.467), and complication rate (p = 0.519) between patients who received the headless compressive screw and those who received the cannulated screw for fixation were not statistically significant.ConclusionsWe demonstrate good clinical results with closed reduction and the percutaneous screw fixation method. Both cannulated and headless compressive screws can be used safely as a treatment method in physeal ankle fractures.

show abstract

“…In addition, SalterHarris fractures may lead to physeal bars, especially those that are higher grade. When physeal bars are eccentrically located in the tibia, varus or valgus deformity of the ankle may result, whereas central physeal bars may lead to restricted growth without angular deformity [ 7 ].…”

Section: Fractures About the Anklementioning

confidence: 99%

“…Tibial fractures accompany approximately 25 % of fi bular fractures [ 7 ], so if there is a fi bular fracture the tibia should be closely examined.…”

Section: Fractures About the Anklementioning

confidence: 99%

The Foot and Ankle: Acquired Disorders

Kan

2014

Pediatric Orthopedic Imaging

View full text Add to dashboard Cite

Injuries to the pediatric ankle and foot are common and increasing due to the popularity of organized youth sports. Fracture and dislocation patterns vary based on skeletal maturity, position of the ankle and foot at the time of injury, and direction of force. Ankle fractures unique to children, such as triplane and juvenile Tillaux, are addressed initially. Fractures of the foot are then presented based on their position within the hindfoot, midfoot, and forefoot. Discussions of osteochondritis dissecans of the talar dome and the various osteochondroses of the mid-and forefoot follow, and the chapter concludes with a brief review of ankle impingement syndromes.Injuries to the pediatric ankle and foot are common and increasing due to the popularity of organized youth sports. Fracture and dislocation patterns vary based on skeletal maturity, position of the ankle and foot at the time of injury, and direction of force. Ankle fractures have unique patterns in children, such as triplane and juvenile Tillaux fractures. Fractures of the foot are addressed based on their position within the hindfoot (talus and calcaneus), midfoot (cuneiforms, cuboid, navicular), and forefoot (metatarsals and phalanges). Osteochondritis dissecans of the talar dome and the various osteochondroses of the mid-and forefoot may cause chronic pain

show abstract

Physeal Fractures of the Distal Tibia and Fibula (Salter-Harris Type I, II, III, and IV Fractures)

Cited by 56 publications

References 13 publications

Radiograph-Negative Lateral Ankle Injuries in Children

Radiograph-Negative Lateral Ankle Injuries in Children

Percutaneous cannulated screw fixation for pediatric epiphyseal ankle fractures

The Foot and Ankle: Acquired Disorders

Contact Info

Product

Resources

About