Mid- and long-term outcomes of surgical treatment for distal tibial physeal fractures.

BACKGROUND

Distal tibial fractures are among the most common injuries in childhood. The treatment of distal tibial physeal fractures presents significant challenges for orthopedic surgeons, and potential complications are a major concern. The aim of this study is to evaluate the mid- and long-term outcomes of patients who underwent surgery for a distal tibial physeal fracture.

METHODS

This retrospective study included 46 patients who underwent surgery for a distal tibial physeal fracture between 2008 and 2022. Patients were evaluated based on the trauma that caused the fracture, the type of fracture (Salter-Harris classification), the type of reduction performed (open or closed), the type of implant used (K-wire or cannulated screw), the location of the fracture in the joint (intra-articular or extra-articular), and the presence of complications. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for clinical assessment.

RESULTS

The median age of the patients was 12 years (interquartile range [IQR] 10-14). The median follow-up time was 67 months (IQR 50.5-107). Postoperative anatomical reduction was achieved in 45 patients (97.8%), while 1 patient (2.2%) failed to achieve anatomical reduction. The median AOFAS score for all patients was 100 (IQR 90-100). Patients treated with K-wire fixation had a median score of 90 (IQR 86.5), while those treated with cannulated screws had a median score of 100 (IQR 92.5-100). Although the score for cannulated screws was statistically significantly higher (p=0.024), both groups demonstrated excellent clinical outcomes.

CONCLUSION

Distal tibial physeal fractures are one of the most common childhood fractures and can lead to severe complications. The mid- and long-term outcomes of surgical treatment of distal tibial physeal fractures are favorable. The method of reduction (open or closed), the choice of implant (K-wire or cannulated screw), and the location of the fracture (intra-articular or extra-articular) do not affect outcomes or complications in patients with these injuries. The crucial factor in the treatment of distal tibial physeal fractures is achieving anatomical reduction.