Factors Influencing Premature Physeal Closure following Physeal Injury of the Ankle in Children

Jung Ryul Kim; Kwang Hun Song

doi:10.4055/jkoa.2008.43.6.672

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Kim and Song: Factors Influencing Premature Physeal Closure following Physeal Injury of the Ankle in Children

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(6): 672-676.

Published online: 31 December 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.6.672

Factors Influencing Premature Physeal Closure following Physeal Injury of the Ankle in Children

Jung Ryul Kim, M.D., Ph.D., Kwang Hun Song, M.D.

Department of Orthopaedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University, Medical School, Jeonju, Korea.

Address reprint requests to Jung Ryul Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Chonbuk National University Medical School, 634-18, Geumam-dong, Dugjin-gu, Jeonju 561-712, Korea. Tel: +82.63-250-1767, Fax: +82.63-271-6538, jrkeem@chonbuk.ac.kr

Abstract

Purpose

To evaluate the factors influencing premature physeal closure (PPC) following physeal fractures of the ankle in children.

Materials and Methods

Forty-eight children with physeal injuries of the ankle were analyzed retrospectively after a minimum follow-up of 1 year. We undertook statistical analysis according to age, gender, cause, fracture type, mechanism of injury, and treatment methods for incidence of PPC.

Results

Ten fractures (28.3%) were complicated by PPC. There were three cases of leg length discrepancy (LLD) more than 2 cm, five cases of angulation with LLD more than 2 cm, and two cases of fibula shortening. There were no correlation between PPC and age, sex, cause, or injury mechanism (p>0.05). There was a statistically significant correlation between the rate of PPC and treatment methods (p=0.018).

Conclusion

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.

Keywords: Children, Ankle, Physeal injuries, Premature physeal closure

Figures and Tables

Fig. 1

A 11-year-old girl left distal tibia physeal injury was treated with closed reduction and cast. (A) Preoperative anteroposterior radiograph shows Salter-Harris type II physeal injury of distal tibia and fibular fracture. (B) Postcast radiograph shows undisplaced distal tibial physeal fracture but distance of medical physis is increased. (C) Radiographs at 3 years after closed reduction shows 3 cm shortening of the left tibia and 10^o varus angulation of the left ankle joint. (D, E) Angulation correction and lengthening with Ilizarov apparatus was done.

Fig. 2

A 7 year-year-old boy sustained physeal injuries of the left ankle. (A) Preoperative radiographs show Salter-Harris type I physeal injury of the left distal tibia and fibula. (B) Postoperative radiograph after closed reduction and percutaneous pinning for distal tibia and closed reduction for distal fibular physeal fracture. (C) At postoperative 5 years, the radiographs show fibular shortening due to premature physeal closure of the distal fibular physis.

Table 1

The Treatment Methods and Premature Physeal Closure according to Fracture Configuration

CR, closed reduction; CRPP, closed reduction and percutaneous pinning; ORIF, open reduction and internal fixation, No., number; PPC, premature physeal closure; ( )=No. of PPC.

References

1. Barmada A, Gaynor T, Mubarak SJ. Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor. J Pediatr Orthop. 2003. 23:733–739.

2. Broock GJ, Greer RB. Traumatic rotational displacements of the distal tibial growth plate. A case report. J Bone Joint Surg Am. 1970. 52:1666–1668.

3. Dias LS, Tachjdian MO. Physeal injuries of the ankle in children: classification. Clin Orthop Relat Res. 1978. 136:230–233.

4. Dingeman RD, Shaver GB Jr. Operative treatment of displaced Salter-Harris III distal tibial fractures. Clin Orthop Relat Res. 1978. 135:101–103.

5. Dugan G, Herndon WA, McGuire R. Distal tibial physeal injuries in children: a different treatment concept. J Orthop Trauma. 1987. 1:63–67.

6. Gruber HE, Phieffer LS, Wattenbarger JM. Physeal fractures, part II: fate of interposed periosteum in a physeal fractures. J Pediatr Orthop. 2002. 22:710–716.

7. Henke JA, Kiple DL. Rotational displacement of the distal tibial epiphysis without fibular fracture. J Trauma. 1979. 19:64–66.

8. Johnson EW Jr, Fahl JC. Fractures involving the distal epiphysis of the tibia and fibula in children. Am J Surg. 1957. 93:778–781.

9. Kling TF Jr, Bright RW, Hensinger RN. Distal tibial physeal fractures in children that may require open reduction. J Bone Joint Surg Am. 1984. 66:647–657.

10. Lovell ES. An unusual rotatory injury of the ankle. J Bone Joint Surg Am. 1968. 50:163–165.

11. Rohmiller MT, Gaynor TP, Pawelek J, Mubarak SJ. Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure? J Pediatr Orthop. 2006. 26:322–328.

12. Nevelös AB, Colton CL. Rotational displacement of the lower tibial epiphysis due to trauma. J Bone Joint Surg Br. 1977. 59:331–332.

13. Phieffer LS, Meyer RA Jr, Gruber HE, Easley M, Wattenbarger M. Effect of interposed periosteum in an animal physeal fracture model. Clin Orthop Relat Res. 2000. 376:15–25.

14. Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 1963. 45:587–622.

15. Spiegel PG, Cooperman DR, Laros GS. Epiphyseal fractures of the distal ends of the tibia and fibula? A retrospective study of two hundred and thirty-seven cases in children. J Bone Joint Surg Am. 1978. 60:1046–1050.

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