Ann Trauma Acute Care | Volume 7, Issue 1 | Research Article | Open Access

Midterm Results after Physeal Separations of the Distal Tibia with Particular Attention to Posttraumatic Growth Disturbances – A Prospective Multicenter Study

Kraus R1,2*, Lieber J2,3 and Leutheuser S4

1Department of Trauma-, Hand- und Reconstructive Surgery, University Hospital, Germany 2Li-La, Licht & Lachen Für Kranke Kinder – Effizienz in der Medizin e.V., Germany 3Clinic for Pediatric Surgery and Pediatric Urology, Universitätsklinikum Tübingen, Germany 4Department of Special Sports Traumatology and Trauma Surgery, Sana Dreifaltigkeits- Krankenhaus Cologne, Germany

*Correspondance to: Ralf Kraus 

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Abstract

Background: Physeal injuries to the distal tibia are known to cause growth disorders. These may occur in the first two years after injury. Many investigations do not differentiate between physeal separations and epiphyseal fractures. This paper reports on the mid-term results including premature growth arrest in a cohort of 150 injuries. Material and Methods: Twenty-one pediatric trauma centers were asked to contribute their subsequent cases over a period of three years, observing each case over a period up to three years prospectively. Results: All children and adolescents returned to sports within one year after injury, but approximately one out of seven did not reach pre-trauma level of sports. We found a share of 12.7% of post-traumatic growth disorders appearing as leg length difference or axial deviation. Only 21.1% of the injured with a growth disorder or 2.7% of all participants needed surgical correction. Our rate of growth disorders and need of surgical correction is lower than in many other publications, which report growth disorders in up to over 40% and the need of secondary surgery in up to two thirds of the cases. Discussion: Most children achieve a good result after physeal separations. We attribute our low rate of significant growth disorders to the fact, that in our series the indication for reduction and operative fixation was provided very strictly in axial deviations of more than 10 degrees primarily. The few surgically relevant growth disorders appear 12 months after injury or later. As growth disorders may appear in between the first two years after injury, a long period of observation needs to be recommended. Conclusion: The rate of growth disorders may be reduced by initially strict indication to reduce posttraumatic axial deviations.

Keywords:

Physeal separation; Distal tibia; Treatment; Follow up; Premature growth arrest

Citation:

Kraus R, Lieber J, Leutheuser S. Midterm Results after Physeal Separations of the Distal Tibia with Particular Attention to Posttraumatic Growth Disturbances – A Prospective Multicenter Study. Ann Trauma Acute Care. 2024; 7(1): 1033..

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