Mid- and long-term outcomes of surgical treatment for distal tibial physeal fractures

Abstract

BACKGROUND: Distal tibial fractures are among the most common injuries in childhood. The treatment of distal tibial physeal fractures presents significant challenges for orthopedic surgeons, and potential complications are a major concern. The aim of this study is to evaluate the mid- and long-term outcomes of patients who underwent surgery for a distal tibial physeal fracture. METHODS: This retrospective study included 46 patients who underwent surgery for a distal tibial physeal fracture between 2008 and 2022. Patients were evaluated based on the trauma that caused the fracture, the type of fracture (Salter-Harris classification), the type of reduction performed (open or closed), the type of implant used (K-wire or cannulated screw), the location of the fracture in the joint (intra-articular or extra-articular), and the presence of complications. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for clinical assessment. RESULTS: The median age of the patients was 12 years (interquartile range [IQR] 10-14). The median follow-up time was 67 months (IQR 50.5-107). Postoperative anatomical reduction was achieved in 45 patients (97.8%), while 1 patient (2.2%) failed to achieve anatomical reduction. The median AOFAS score for all patients was 100 (IQR 90-100). Patients treated with K-wire fixation had a median score of 90 (IQR 86.5), while those treated with cannulated screws had a median score of 100 (IQR 92.5-100). Although the score for cannulated screws was statistically significantly higher (p=0.024), both groups demonstrated excellent clinical outcomes. CONCLUSION: Distal tibial physeal fractures are one of the most common childhood fractures and can lead to severe complications. The mid- and long-term outcomes of surgical treatment of distal tibial physeal fractures are favorable. The method of reduction (open or closed), the choice of implant (K-wire or cannulated screw), and the location of the fracture (intra-articular or extra-articular) do not affect outcomes or complications in patients with these injuries. The crucial factor in the treatment of distal tibial physeal fractures is achieving anatomical reduction.