Premature Physeal Closure after a Non-Displaced Physeal Fracture of Distal Fibula

Surgical Case Reports ◽

10.31487/j.scr.2021.06.08 ◽

2021 ◽

pp. 1-3

Author(s):

Antti Stenroos ◽

Topi Laaksonen ◽

Jussi Kosola ◽

Yrjänä Nietosvaara ◽

Antti Stenroos

Keyword(s):

Corrective Osteotomy ◽

Distal Tibia ◽

Angular Deformity ◽

Leg Length ◽

Post Injury ◽

Distal Fibula ◽

Physeal Fracture ◽

Clinically Significant ◽

Physeal Closure ◽

Displaced Fracture

Premature physeal closure (PPC) may lead to clinically significant progressive angular deformity or leg length discrepancy. Many variables seem to play a role in determining which injuries result in PPC. A 8- year-old boy sustained a non-displaced physeal fracture of distal tibia and fibula. He showed no signs of PPC at 7 months post-injury. Seven years later, his ankle became painful. He had developed PPC of distal fibula causing angular ankle deformity, which was treated successfully by corrective osteotomy. To our knowledge, this is the first reported case of a non-displaced fracture of the distal fibula leading to PPC several years after the initial injury, which in our understanding was impossible to predict.

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The Mid-term outcomes of ankle Dias-Tachdjian PEER physeal fracture in children treat by ORIF with One-stage medial-lateral combined incision

10.21203/rs.3.rs-18892/v1 ◽

2020 ◽

Author(s):

Feng XIANG ◽

Bo LI ◽

Sheng XIAO ◽

Jie Wen ◽

Hong LIU ◽

...

Keyword(s):

External Rotation ◽

Distal Tibia ◽

Angular Deformity ◽

X Rays ◽

Physeal Fracture ◽

One Stage ◽

Lateral Incision ◽

Post Operation ◽

Physeal Closure

Abstract Objectives: To report the mid-term outcomes and complications of ankle Dias-Tachdjian pronation-eversion external rotation (PEER) physeal fracture in children treat by ORIF with combined medial and lateral incision. Materials and Methods: A total of 21 children (12 male and 9 female patients with ankle Dias-Tachdjian PEER physeal fracture, underwent open reduction treatment with combined medial and lateral incision between Jan, 2015 and Oct, 2017. The surgical outcomes were assessed by X-ray film after operation. The lateral distal tibia angle (LDTA) was measured to evaluate angular deformity and the X rays was taken to evaluate the premature physeal arrest. Result: All the patients were followed up for an average time of 20.1 months (ranging from 17 to 25 months). Bone healing was achieved in all cases. American Orthopedic Foot and Ankle Society-Ankle and Hindfoot score(AOFAS-AH) of the patients improved from median 31(11,38) before operation to median 68(63,73) post-operation, median score 91(87,96) at last follow-up. Lateral distal tibia angle (LDTA) of the patients improved from 70.5±4.9 before operation to 90.0±1.2 post-operation, measure 90.6±3.7 at last follow-up. The differences between pre and post operation and the differences between pre-operation and last follow-up in both findings were statistically significant (P<0.05). There is no premature physeal closure, ankle deformity in 19 cases. They could normally exercise and take part in normal sport activities. The remaining 2 cases had physeal bone bridge and premature physeal closure but could still carry on daily activities and thus were categorized as good. Conclusion: ORIF with one-stage medial-lateral combined incision for ankle Dias-Tachdjian PEER physeal fracture in children can decrease the rate of premature physeal closure and has excellent efficacy for fracture union and the recovery of ankle functions.

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Traumatic physeal fractures in cats: a review of 36 cases (2010–2020)

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211005886 ◽

2021 ◽

pp. 1098612X2110058

Author(s):

Carlos Rubinos ◽

Richard L Meeson

Keyword(s):

Distal Tibia ◽

Fracture Repair ◽

Implant Removal ◽

Type I ◽

Physeal Fracture ◽

Physeal Closure ◽

Femoral Physis ◽

Clinical Records ◽

Physeal Fractures

Objectives The aim of this study was to describe the demography, aetiology, location and classification of physeal fractures in cats, and to describe their management and outcomes. Methods Clinical records and radiographs of cats referred for management of physeal fractures were retrospectively reviewed. Fractures of the proximal femoral physis were excluded. Descriptive statistics were used to describe signalment, cause of injury, presence of concurrent injuries, fracture description, treatment modality, complications, follow-up, physeal closure, implant removal and outcome. Results Thirty-four cats with 36 fractures were included, of which 17 affected the distal femur, 11 the distal tibia and fibula, five the distal radius and ulna, two the proximal tibia and one the distal humerus. Salter–Harris classification was type I in 14, type II in 16, type III in two and type IV in four fractures. Thirty-four fractures were treated with primary fixation, and the most common method was crossed Kirschner wires (24/34 fractures). Complications were observed in 14 fractures, of which 12 were minor. At radiographic follow-up, physeal closure was reported in 23 fractures, of which 15 were considered premature. Implant removal was performed in three fractures. Outcome was good in 28, fair in four and poor in two fractures. Conclusions and relevance Fracture of the distal femoral physis was the most common physeal fracture seen. Cats presenting with physeal fractures may be skeletally immature or mature with delayed physeal closure. The rate of physeal closure after fracture repair was relatively high but without apparent impact. The frequency of implant removal was very low, indicating that despite having a physeal fracture repair, most cats did not require a second procedure to remove implants. Overall, internal fixation provided a good outcome in most fractures.

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Correction of Posttraumatic Medial Growth Arrest of the Distal Tibia in Adolescents

Foot & Ankle Specialist ◽

10.1177/19386400211029130 ◽

2021 ◽

pp. 193864002110291

Author(s):

Pavel Kotlarsky ◽

Khaled Abu Dalu ◽

Mark Eidelman

Keyword(s):

Ankle Joint ◽

Distal Tibia ◽

Growth Arrest ◽

Treatment Protocol ◽

Case Series ◽

Tibial Osteotomy ◽

Leg Length ◽

Joint Orientation ◽

Distal Fibula ◽

Case Series Study

Background Partial growth arrest of the medial part of the distal tibial physis following fractures that penetrated the epiphysis is relatively common. We present the results of treatment, based on a protocol of supramalleolar tibial and fibular osteotomy for ankle alignment correction, and contralateral epiphysiodesis of distal tibia and fibula to balance leg length discrepancy (LLD). Methods This case series study describes the results of 7 patients with a median age of 14 years (range = 10-15 years) who were operated in our institution. All were treated by closed or open reduction and internal fixation after Salter-Harris (SH) types 3 and 4 fractures of the distal tibia. All patients had a partial medial growth arrest, distal tibial varus, relative overlengthening of the distal fibula, and slight leg shortening. Treatment Protocol Contralateral distal tibial and fibular epiphysiodesis to prevent significant LLD, completion of closure of the ipsilateral epiphysis, supramalleolar osteotomy of the distal tibia and fibula, and insertion of a triangular wedge cortical allograft into the tibial osteotomy creating a normal ankle joint orientation. The osteotomy was supported by a medial anatomically contoured locking plate. The fibula was fixed with an intramedullary wire. Results All patients had uneventful healing of the osteotomy after 6 weeks. At the latest follow-up (mean 3 years, range 1.5-5 years), 6 out of 7 patients reached maturity, and the lateral distal tibial angle was within normal limits. The LLD in all patients was less than 8 mm. Conclusions Our protocol provides anatomic correction with the restoration of the ankle joint and prevents the progression of LLD. Levels of Evidence: Level IV

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Open Reduction and Internal Fixation for Displaced Salter-Harris type II Fractures of the Distal Tibia: A Retrospective Study of Eighty-Five Cases in Children

10.21203/rs.3.rs-151742/v1 ◽

2021 ◽

Author(s):

Quanwen Yuan ◽

Yunfang Zhen ◽

Zhixiong Guo ◽

Fuyong Zhang ◽

Jianfeng Fang ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Distal Tibia ◽

Open Reduction Internal Fixation ◽

Angular Deformity ◽

Initial Displacement ◽

Fibular Fracture ◽

The Mean ◽

Salter Harris ◽

Physeal Closure

Abstract Background: The treatment for displaced Salter-Harris Ⅱ distal tibia fractures remains controversial. The purpose of this study was to evaluate the rate of premature physeal closure (PPC) and to identify the risk factors treated by open reduction and internal fixation.Methods: We reviewed the charts and radiographs of patients with Salter-Harris Ⅱ fractures of the distal tibia with displacement >3mm between 2012 and 2019. Open reduction and internal fixation was performed for all patients. Patients were followed up for a minimum of 4 months. Contralateral ankle radiograph or CT scans were obtained if there was any evidence of premature physeal closure. Any angular deformity or shortening of the involved leg was documented.Results: A total of 85 patients with a mean age of 12.3years were included in the study. The mean initial displacement was 8.5 mm. All patients but one were treated within seven days after injury and the mean interval was 3.7 days. SER injuries occurred in 65 patients (76.5%), PER in 17 (20.0%), and SPF in three (3.5%). The rate of PPC was 29.4% and two patients with PPC had varus deformities. The rate of PPC was significantly greater in patients with associated fibular fracture as compared with those with intact fibular (P=0.005). Patient age, gender, injured side, mechanism of injury (only SER vs PER), amount of initial displacement, interval from injury to surgery, or energy of injury did not affect the rate of PPC significantly. Conclusions: PPC is a common complication for displaced S-H Ⅱ distal tibia physeal fractures. We suggest that open reduction internal fixation is an effective choice to reduce the risk of PPC. The presence of concomitant fibula fracture was associated with PPC.

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Osteotomy for Correction of Premature Growth Plate Closure in 24 Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633134 ◽

1994 ◽

Vol 07 (03) ◽

pp. 129-135 ◽

Cited By ~ 8

Author(s):

C.W. Miller ◽

P.W. Morgan

Keyword(s):

Corrective Osteotomy ◽

Functional Results ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Angular Deformity ◽

Dynamic Correction ◽

Age At Surgery ◽

Limb Deformities ◽

The Mean ◽

A Prospective Study

SummaryTwenty-four dogs (27 limbs) were evaluated after surgery for correction of forelimb angular limb deformities. Partial ulnar ostectomies or definitive corrective osteotomies were performed depending upon the age of the dog. According to owner assessment nine of fourteen limbs were considered functionally good, or excellent, after partial ulnar ostectomies. Younger dogs appeared to have better functional results after dynamic correction with the mean age at surgery of dogs with good to excellent results being 6.5 months contrasted to the mean age at surgery of dogs with fair to poor results being 9.75 months. Ten of fourteen limbs were considered functionally good or excellent after definitive corrective osteotomy. One dog had definitive osteotomy after partial ulnar ostectomy in order to further correct a residual angular deformity. However, 58% of the limbs with radiographic follow-up had signs of degenerative joint disease (DJD). There were not significant differences between neither degree of angulation remaining after surgery and the functional result nor the degree of angulation remaining after surgery and the development of DJD. A prospective study is warranted to more objectively assess the efficacy of surgical correction of angular limb deformities in dogs.Twenty-four dogs were evaluated after surgery for correction of forelimb angular limb deformities. The results are described.

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Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents

Injury ◽

10.1016/j.injury.2021.01.014 ◽

2021 ◽

Author(s):

Hyon Soo Jung ◽

Moon Seok Park ◽

Kyoung Min Lee ◽

Kug Jin Choi ◽

Woo Young Choi ◽

...

Keyword(s):

Risk Factors ◽

Children And Adolescents ◽

Distal Tibia ◽

Growth Arrest ◽

Physeal Fracture

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Monomelic Maffucci syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-239619 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239619

Author(s):

Gopalkrishna G Verma ◽

Vijay Kumar Jain ◽

Karthikeyan P Iyengar

Keyword(s):

Lower Limb ◽

Corrective Osteotomy ◽

Valgus Deformity ◽

Left Knee ◽

Leg Length ◽

Maffucci Syndrome ◽

Successful Clinical Outcome ◽

Genu Valgus Deformity ◽

Angular Deformities

Maffucci syndrome is a rare congenital, non-hereditary condition characterised by presence of multiple enchondromas and haemangiomas. Enchondromatous lesions affecting epiphysial growth plates can lead to angular deformities and leg-length discrepancy in the lower limb. We describe a 12-year-old girl with monomelic Maffucci syndrome affecting her left lower limb. She presented with progressive genu valgus deformity of her left knee. This caused her to limp during her gait and was a cosmetic dissatisfaction. The deformity affected her quality of life. She underwent a supracondylar distal femoral corrective osteotomy with a successful clinical outcome and restoration of her gait and cosmetic deformity.

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Long term results after transepiphysal ACL reconstruction in children and adolescent

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00017 ◽

2018 ◽

Vol 6 (4_suppl2) ◽

pp. 2325967118S0001

Author(s):

Christian Eberle ◽

Wolfgang Schopf ◽

Andree Ellermann

Keyword(s):

Acl Reconstruction ◽

Cartilage Damage ◽

Long Term Results ◽

Angular Deformity ◽

Leg Length ◽

Growth Disturbance ◽

Children And Adolescent ◽

The Mean

The aim of our study was to review the long term clinical and radiological (MRI) outcomes of adult patients who underwent ACL reconstruction as children or adolescent with emphasize to the features of growth disturbance, angular deformity, meniscal and cartilage damage and revision rate We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence between the years 1997 and 2009. A total of 43 Patients were assessed. 25 male and 18 female. The average age at time of surgery was 13,5 years (8 - 16 y.), at time of assessement 22,4 years (18 - 30 y.) . The mean follow up was 10 years (4 - 16 years). The physical development of the patients was assessed with the Lysholm score and the Cincinnati Knee score scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner activity score . Leg deformity or leg length discrepancy was evaluated clinically by the observers. The instrumented Lachman test using KT1000 and manual Pivot shift test was performed to assess knee stability. MRI was used to detect graft integrity, cartilage and meniscal damages. No significant leg deformities or leg length discrepancy had been detected. The average Lysholm score was 91 points (83 - 100), the Cincinnati Knee Score was 90,4 (79 - 100) points on average . The mean IKDC score was 92 points (82 -100). The Tegner-Activity-Score changed from preop 6,8 (2-10) to post op 5,8 (2-9). 2 Patient underwent revision ACL reconstruction due to rerupture (3 and 9 years post op). 2 Patients underwent meniscal surgery during follow up (1 resection and one refixation). KT1000 evaluation showed 67% excellent, 21% good and in 12% bad results. The MRI scan showed 42 intact grafts and one unverifiable graft. One patient with cartilage damage up to 3° (ICRS), 3 patients with meniscal degeneration up to grade 2. Each patient showed a free range of motion Our data underlines that transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long term results without causing angular deformity or growth disturbance

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