Rachel A Thomas1, William L Hennrikus2. 1. Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, 500 University Drive, Mail Box 593, Hershey, PA 17033 United States. Electronic address: rthomas8@pennstatehealth.psu.edu. 2. Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, 500 University Drive, Mail Box 593, Hershey, PA 17033 United States.
Abstract
BACKGROUND: Distal Salter-Harris (SH) II fractures of the tibia are common injuries in the pediatric population. The purpose of this study is to evaluate our treatment and outcomes of SH II fractures of the distal tibia. METHODS: The study was approved by the medical school's institutional review board (IRB). Fifty-one distal tibia SH type II fractures were treated from 2003 to 2017. We performed a retrospective review of all patients. Patients with displacement less than 3 mm, on x-ray, were treated with a cast. Patients with displacement greater than or equal to 3 mm displacement were initially treated with closed reduction in the emergency department with conscious sedation. Patients were also categorized based on the mechanism of injury and complications were noted. Patients were followed for an average of 4 months (range, 4 weeks-28 months). RESULTS: Fifty-one patients, 28 females and 23 males, were included in the study, with a mean age of 9.4 years (range, 13 months-13 years) at presentation. The most common mechanism of injury was participation in sports (43%). Out of the 51 patients, 45 were minimally displaced and treated with cast. Six displaced fractures were treated with closed reduction. The mean displacement in the closed reduction group at presentation was 5.7 (range, 3- 8.8) mm. Five out of 6 patients had reduction to less than 3 mm. The overall complication rate was 1 out of 51 patients, 2%. When examining displaced fractures, the complication rate was 1 out of 6 patients, 17%. CONCLUSION: Most SH II fractures of the distal tibia are minimally displaced and do not need a reduction. 6/51 cases (12%) in the current study were displaced and were indicated for a reduction. Displacement greater than or equal to 3 mm can be treated with closed reduction followed by a cast; if closed reduction fails, open reduction is indicated. Displaced fractures have a small risk of growth arrest.
BACKGROUND: Distal Salter-Harris (SH) II fractures of the tibia are common injuries in the pediatric population. The purpose of this study is to evaluate our treatment and outcomes of SH II fractures of the distal tibia. METHODS: The study was approved by the medical school's institutional review board (IRB). Fifty-one distal tibia SH type II fractures were treated from 2003 to 2017. We performed a retrospective review of all patients. Patients with displacement less than 3 mm, on x-ray, were treated with a cast. Patients with displacement greater than or equal to 3 mm displacement were initially treated with closed reduction in the emergency department with conscious sedation. Patients were also categorized based on the mechanism of injury and complications were noted. Patients were followed for an average of 4 months (range, 4 weeks-28 months). RESULTS: Fifty-one patients, 28 females and 23 males, were included in the study, with a mean age of 9.4 years (range, 13 months-13 years) at presentation. The most common mechanism of injury was participation in sports (43%). Out of the 51 patients, 45 were minimally displaced and treated with cast. Six displaced fractures were treated with closed reduction. The mean displacement in the closed reduction group at presentation was 5.7 (range, 3- 8.8) mm. Five out of 6 patients had reduction to less than 3 mm. The overall complication rate was 1 out of 51 patients, 2%. When examining displaced fractures, the complication rate was 1 out of 6 patients, 17%. CONCLUSION: Most SH II fractures of the distal tibia are minimally displaced and do not need a reduction. 6/51 cases (12%) in the current study were displaced and were indicated for a reduction. Displacement greater than or equal to 3 mm can be treated with closed reduction followed by a cast; if closed reduction fails, open reduction is indicated. Displaced fractures have a small risk of growth arrest.
Authors: Joseph R Fuchs; Romie F Gibly; Christopher B Erickson; Stacey M Thomas; Nancy Hadley Miller; Karin A Payne Journal: Children (Basel) Date: 2022-06-18