Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents |
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| Affiliation: | 1. ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand;2. Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa;3. Director, School Health, Ministry of Education, Monrovia, Liberia;4. Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam;5. Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam;1. Graduate Program in Surgery and Translational Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil;2. Department of Structural and Functional Biology (Anatomy Sector), Institute of Biosciences, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil;3. Center for the Studies of Venoms and Venomous Animals (CEVAP), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil;4. Herminio Ometto University Center (Uniararas), Araras, São Paulo, Brazil;1. Emergency Department, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands;2. Emergency Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ ’s Hertogenbosch, The Netherlands;1. University of Calgary, Section of Orthopaedics, Department of Surgery, Foothills Medical Center, 29th St. NW, Calgary, Alberta T2N 5A1, Canada;2. University of British Columbia, Department of Orthopaedics, Faculty of Medicine, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia V5Z 1M9, Canada;3. University of Calgary, 0490 McCaig Tower, Foothills Medical Center, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada;1. King''s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King''s College London, London, UK;2. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK;3. Karonga District Hospital, Karonga District Health Office, Karonga, Malawi;4. Mzuzu Central Hospital, Department of Orthopaedic Surgery, Mzuzu, Malawi;5. Malawi Epidemiology and Intervention Research Unit (MEIRU), Chilumba, Karonga District Malawi;6. Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK;7. Centre for Applied Health Research, University of Birmingham, Birmingham, UK;8. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;9. Extraordinary Professor, Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town;1. Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital Yuanshan Branch, Taiwan, ROC;2. Department of Orthopaedics; School of Medicine; National Yang-Ming University, Taiwan, ROC;3. Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taiwan, ROC;4. Department of Radiology; School of Medicine; National Yang-Ming University, Taiwan, ROC;5. Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taiwan, ROC;6. Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taiwan, ROC |
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| Abstract: | Background. This study performed to investigate the incidence of growth arrest such as leg length discrepancy (LLD) and ankle joint angular deformity and its risk factors after physeal fracture of the distal tibia in children and adolescents.Materials and Methods. Consecutive 78 patients (mean age 11.4 ± 2.0 years; mean follow-up period 2.0 ± 1.2 years) treated for the distal tibia physeal fracture were included. All patients underwent preoperative ankle radiographs, three-dimensional computed tomography (CT) scans, and postoperative follow-up teleradiogram. Patients were divided into two groups according to the LLD and the difference of lateral distal tibial angle (LDTA) with the contralateral limb as follows: Group 1 (growth arrest), patients with LLD ≥ 1cm or difference of LDTA ≥ 5°; Group 2 (normal growth), patients with LLD < 1cm and difference of LDTA < 5°.Results. The overall incidence of growth arrest was 12.8% (10 of 78). The mean displacement measured using CT scan was 4.4 ± 3.2 mm (range, 0.8-14.9). Of the total 78 fractures, 65 were treated surgically and 13 fractures were treated conservatively. The initial fracture displacement was significantly different between the two groups (p<0.001). However, there were no statistically significant differences between the two groups with respect to other factors. Initial displacement was the only significant risk factor for growth arrest (p<0.003). The cutoff values of initial displacement between the two groups were 5.2mm.Conclusions. This study showed that degree of initial displacement was the only significant risk factor for growth arrest after physeal fracture of the distal tibia in children and adolescents. Therefore, physicians should consider the possibility of growth arrest for patients with severely displaced physeal fractures of the distal tibia. |
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