Growth disturbances after distal tibial physeal fractures

Twenty-four patients with distal tibial growth disturbance were reviewed. D isturbances were classified as physeal bar (prior to deformity), angular, l inear or combined deformities. Treatment consisted of osteotomy in fourteen , epiphyseodesis in seven, excision of bony bar in two, and observation in one patient. Follow up was an average 36.6 months (range 4-129 months) afte r treatment of growth disturbance. The age at time of injury was 10.4 years of age average (range 3-15 years). There were 12 SH2, 2 SH3, 7 SH4, and 3 SH5 distal tibial physeal fractures. Thirteen of 15 fractures considered hi gh energy and only 1 of 9 fractures considered low energy resulted in angul ar deformity. Angular and linear deformities presented an average 46 months (range 12-120 months) and physeal bars at an average 14 months (range 6-25 months) after injury. Patients with a delay in presentation of growth dist urbance greater than 24 months had angular deformities in 92% compared with 33% in children presenting less than or at 24 months. Treatment based on t ype of deformity, age at time of injury, and growth remaining was considere d successful in 83%. Patients with angular or linear deformities were more likely to present lat e, have high energy injuries, be male patients and have Salter-Harris types IV and V. Early diagnosis and treatment of growth disturbance can prevent severe deformity.