Salter-Harris type II fractures of the distal tibia: Residual postreduction displacement and outcomes-a STROBE compliant study.
Margalit, Adam MD; Peddada, Kranti V. MD; Dunham, Alexandra M. MD; Remenapp, Craig M. MS; Lee, R. Jay MD *
99(9):e19328, February 2020.
(Format: HTML, PDF)
We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.
Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean ( /-SD) age at injury of 12.0 /- 2.2 years. Mean maximum fracture displacements were 6.6 /- 6.5 mm initially, 2.7 /- 2.0 mm postreduction, and 0.4 /- 0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement >=4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 /- 2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).
The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.
Level of Evidence: Level IV, case series
Copyright (C) 2020 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.