Incidence of growth disturbance after distal tibia physeal fracture in children

BACKGROUND: To analyze the growth disturbance after distal tibia physeal fracture in children. METHODS: Data about children with distal tibia physeal fractures between September 2015 to September 2018 were collected, including age, gender, affected side, Salter–Harris classification, initial maximal displacement, with or without fibula fracture, open or closed reduction, the method of fixation, time to surgery, blood loss, duration of operation, and complications. Patients were placed in the growth disturbance group when leg length discrepancy was equal to or greater than 1.5 cm, or when they had more than 5 degrees of varus or valgus deformity. Others were placed in the no-growth disturbance group. RESULTS: A total of 143 patients (96 boys and 47 girls) were enrolled in this study. The length of the follow-up periods averaged 29.34 ± 7.46 months (26 to 61 months). Among the total of 143 patients, the incidence of growth disturbance was 15.39% (22/143). The no-growth disturbance group consisted of 121 patients (84 boys and 37 girls), with a mean age of 11.50 ± 3.20 years, and there were 68, 52, and 1 injuries to the left, right, and bilateral sides, respectively. The average maximal displacement was 5.51 ± 3.18 mm, and 27.27% (33/121) of patients also had a fibula fracture. The growth disturbance group contained 22 patients (12 boys and 10 girls) with a mean age of 9.32 ± 3.56 years, and there were 12, 10, and 0 injuries on the left, right, and bilateral sides, respectively. The average maximal displacement was 5.77 ± 4.89 mm, and 45.45% (10/22) of patients also had a fibula fracture. There was a significant difference in age (p = 0.004) and fibula fracture (p = 0.011) between the two groups. More patients had Salter–Harris types III and IV fractures in the growth disturbance group than in the no-growth disturbance group (p = 0.043). CONCLUSIONS: Children with Salter–Harris types III and IV fractures, younger children, and children with fibula fractures all have a higher incidence of growth disturbance after distal tibia physeal fractures. LEVEL OF EVIDENCE: Level III-Prognostic study.