Dorien Schneidmueller1, Ingo Marzi. 1. Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. dorien.schneidmueller@kgu.de
Abstract
OBJECTIVE: Injury to the epiphyseal cartilage during the period of growth plate closure in adolescence results in specific stereotyped injury patterns due to the change in biomechanics. According to the number of fragments, fractures of the distal tibia can be categorized into so-called two-plane and triplane I and II fractures. Since these fractures are involving the joint, the most important aspect for further therapy is the reconstruction of the joint surface. As the growth plate has already begun to close at this stage, relevant growth disturbances are unlikely. INDICATIONS: Fracture dislocation > 2 mm. CONTRAINDICATIONS: Undislocated fractures. Usual surgical and anesthetic risks. SURGICAL TECHNIQUE: Closed bone reduction is suitable for most minimally displaced fractures but in uncertain cases with advanced displacement, operative reduction may be necessary. The osteosynthesis can be achieved preferably by cannulated screws which, depending on the localization, can be placed intersecting the growth plate. POSTOPERATIVE MANAGEMENT: Basically, plaster immobilization is not necessary in case of stable osteosynthesis. Depending on the patient's cooperation and the fracture stability, a lower-leg cast may additionally be applied. Non-weight bearing for 6 weeks. RESULTS: While short-term results are generally good, data on long-term outcome and possible development of arthrosis is still insufficient.
OBJECTIVE: Injury to the epiphyseal cartilage during the period of growth plate closure in adolescence results in specific stereotyped injury patterns due to the change in biomechanics. According to the number of fragments, fractures of the distal tibia can be categorized into so-called two-plane and triplane I and II fractures. Since these fractures are involving the joint, the most important aspect for further therapy is the reconstruction of the joint surface. As the growth plate has already begun to close at this stage, relevant growth disturbances are unlikely. INDICATIONS: Fracture dislocation > 2 mm. CONTRAINDICATIONS: Undislocated fractures. Usual surgical and anesthetic risks. SURGICAL TECHNIQUE: Closed bone reduction is suitable for most minimally displaced fractures but in uncertain cases with advanced displacement, operative reduction may be necessary. The osteosynthesis can be achieved preferably by cannulated screws which, depending on the localization, can be placed intersecting the growth plate. POSTOPERATIVE MANAGEMENT: Basically, plaster immobilization is not necessary in case of stable osteosynthesis. Depending on the patient's cooperation and the fracture stability, a lower-leg cast may additionally be applied. Non-weight bearing for 6 weeks. RESULTS: While short-term results are generally good, data on long-term outcome and possible development of arthrosis is still insufficient.