Lower limb deformity following proximal tibia physeal injury: long-term follow-up

BACKGROUND: Proximal tibial physeal injuries are quite rare, but their complications can be of great importance. The purpose of this study was to evaluate the effect of this injury on the axis and length of a child’s limb. MATERIALS AND METHODS: This study focused on 12 patients with proximal physeal injury of the tibia (8 boys and 4 girls; mean age at the time of injury: 8.9 years). Injuries were classified according to the Salter–Harris scheme into 5 types (type II—7 patients, type III—3 patients, type IV—1 patient, type V—1 patient). In 5 cases, a coexisting fracture of the injured limb was observed (fibular fracture—3 cases, intercondylar fracture—1 case, tibial tubercle fracture—1 case). Ten patients were treated conservatively and 2 patients underwent an operation. Seven of the 12 patients were available for long-term follow-up, with a mean duration of 14.4 years (11.2–22.0 years). RESULTS: Angular deformity was observed in 6 of the 7 patients, with a mean valgus deformity of 2.7°, within an average of 5.8 months after the injury. After 3 years of follow-up, complete remodeling was observed in all of those 6 cases (4 of the patients were treated conservatively and 2 underwent surgery). One patient developed 6 mm of tibial shortening. No functional limitation or pain was recorded in any of the patients during the follow-up. CONCLUSIONS: Injury to the proximal tibial epiphysis, while rare, may result in angular or length disturbance, regardless of the initial treatment (conservative or surgical). Parents should always be informed of this possibility, and long follow-up is indicated. Nevertheless, this type of injury rarely results in functional limitations.