Irreducible Salter-Harris type II fracture of the distal tibial epiphysis.

An 11-year-old boy was admitted to the hospital after he fell to the ground from the roof, complaining of pain in his left ankle. Radiographs showed a Salter-Harris type II fracture-separation of the distal tibial epiphysis together with a transverse bending fracture of the distal fibula. An attempt at closed reduction was unsuccessful. At open reduction, torn periosteum and the posterior tibial tendon were interposed between the tibial metaphysis and epiphysis. After the tendon was deflected to its normal position, fracture-separation of the distal tibial epiphysis was easily reduced. At the latest follow-up 4 years after surgery, radiographs showed no evidence of growth arrest or residual deformity.