FRACTURES OF THE PROXIMAL TIBIAL EPIPHYSIS IN ADOLESCENCE, A REPORT OF 13 CASES

Introduction The goal of this study was to evaluate the mid-term follo w-up of fractures of the proximal tibial epiphysis. Material and metho ds From January 1981 to May 1987, 12 male teenagers sustaining 13 frac tures of the proximal tibial epiphysis were treated in our institution . 9 patients totalizing 10 fractures were reviewed with a minimal 5 ye ars follow-up. Results All knees were painless with a symmetric range of motion except in one case with a 15 degrees flexion lag. One case o f PCL deficiency was observed. Differences in femoro-tibial angles bet ween both limbs was under 5 degrees in 7 of the 9 patients. In 2 cases , an evolving deformity was noted. Differences in posterior epiphyseal tibial tilt between both knees was over 5 degrees in 2 of the 8 unila teral cases. In 1 surgically treated patient an evolving deformity was noted. Mean tibial length discrepancy (T.L.D.) was over 10 millimeter s in 1 case with evolving discrepancy. 3 cases of asymptomatic minimal post traumatic arthritis were noticed. Discussion In our series, as o pposed to most others, Salter-Harris type IV fracture was the most oft en encountered due to the advanced age of our patients. Unusual cases, such as 2 triplane fractures and Salter-Harris type II avulsion fract ure, were present. Lateral ligament insufficiency was noted in case of varus malalignement of the fractured limb. Due to the advanced age of our patients, no major T.L.D. was noted, but frontal or sagittal mala lignement occurred in half of the unilateral cases, 50 per cent of whi ch were proved to be evolutive. Arthritic remodeling was noticed only in cases of Salter-Harris type IV when aggravated by limb malalignemen t. Conclusion Fractures of the proximal tibial epiphysis are mainly en countered in late adolescence with an unusual proportion of Salter-Har ris type III and IV fractures. In spite of their advanced age, these p atients are at high risk for limb malalignement which can increase. We have noted the incidence of arthritic remodeling in Salter-Harris typ e IV fracture. A longer follow-up is needed to determine if these chan ges will have clinical relevance.