Salter-Harris I and II Fractures of the Distal Tibia

Rohmiller, Michael T.; Gaynor, Tracey; Pawelek, Jeff; Mubarak, Scott J.

doi:10.1097/01.bpo.0000217714.80233.0b

Cited by 88 publications

(45 citation statements)

References 26 publications

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“…These predictors were chosen a priori based on our own hypotheses and previous literature (Rohmiller et al. 2006 , Leary et al. 2009 , Russo et al.…”

Section: Methodsmentioning

confidence: 99%

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

et al. 2017

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Background and purposeThe optimal treatment of displaced Salter–Harris (SH) II fractures of the distal tibia is controversial. We compared the outcomes of operative and nonoperative treatment of SH II distal tibial fractures with residual gap of >3 mm. Factors that may be associated with the incidence of premature physeal closure (PPC) were analyzed.Patients and methodsWe retrospectively reviewed 95 patients who were treated for SH II distal tibial fractures with residual gap of >3 mm after closed reduction. Patients were assigned to 1 of 2 groups: Group 1 included 25 patients with nonoperative treatment, irrespective of size of residual gap (patients treated primarily at other hospitals). Group 2 included 70 patients with operative treatment. All patients were followed for ≥ 12 months after surgery, with a mean follow-up time of 21 months. Logistic regression analyses were performed to identify risk factors for the occurrence of PPC.ResultsThe incidence of PPC in patients who received nonoperative treatment was 13/52, whereas PPC incidence in patients who received operative treatment was 24/70 (p = 0.1). Multivariable logistic regression analysis determined that significant risk factors for the occurrence of PPC were age at injury, and injury mechanism. The method of treatment, sex, presence of fibular fracture, residual displacement after closed reduction, and implant type were not predictive factors for the occurrence of PPC.InterpretationOperative treatment for displaced SH II distal tibial fractures did not seem to reduce the incidence of PPC compared with nonoperative treatment. We cannot exclude that surgery may be of value in younger children with pronation–abduction or pronation–external rotation injuries.

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“…These predictors were chosen a priori based on our own hypotheses and previous literature (Rohmiller et al. 2006 , Leary et al. 2009 , Russo et al.…”

Section: Methodsmentioning

confidence: 99%

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

et al. 2017

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“…However, there are many indications that open reduction and internal fixation of deviated fractures greatly reduce the risk of premature closures when compared with conservative therapy 11, 12, 13. Many studies have shown better long-term outcomes in patients treated with anatomical reduction 14, 15, 16…”

Section: Malleolar Fracturesmentioning

confidence: 99%

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Rammelt

Godoy‐Santos

Schneiders

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.

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“…Failure of closed reduction due to interposed periosteum is more common and is more likely in tibial fractures with greater than 20% displacement and where there is an associated fibula fracture [5]. Where the distal tibial epiphysis is involved anatomical reduction is vital to allow timely closure of the physis [7]. In addition, the close proximity of neurovascular structures at this level makes them prone to simultaneous entrapment at the fracture site.…”

Section: Discussionmentioning

confidence: 99%

Tibiofibula Transposition in High-Energy Fractures

Loughenbury

Gledhill

Evans

2016

Case Reports in Emergency Medicine

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We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia. Open reduction and exposure of the fracture sites revealed that the distal fibula fragment was “transposed” and entrapped in the medulla of the proximal tibial fragment. Reduction required simulation of the mechanism of injury in order to disengage the fragments and allow reduction. Tibiofibula transposition is a rare complication of high-energy lower limb fractures which has not previously been reported and may prevent adequate closed reduction. Impaction of the distal fibula within the tibial medulla occurs as the limb is realigned by paramedic staff before transfer to hospital. We recommend that when this complication is identified the patient is transferred to the operating room for open reduction and stabilization of the fracture.

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Salter-Harris I and II Fractures of the Distal Tibia

Abstract: PPC is a common problem following SH type I or II fractures of the distal tibia. Operative treatment may decrease the frequency of PPC in some fractures. Regardless of treatment method, we recommend anatomic reduction to decrease the risk of PPC.

Cited by 88 publications

References 26 publications

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Tibiofibula Transposition in High-Energy Fractures

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