Distal tibia physeal fractures and premature growth arrest

Background: Distal tibia children’s physeal fractures can cause growth complications, as premature physeal closure (PPC), which is radiographic growth plate closure compared to unaffected side. Methods: Retrospective analysis of 243 patients, conducted to assess occurrence of physeal growth arrest. The study aims to identify factors associated with risk of PPC, investigate how common these complications are and to identify factors might predict their occurrence. Data of 243 children with distal tibial physeal fractures were reviewed in multiple military hospitals in Jordan between January 2018 and October 2023. Results: Average follow-up was 37 weeks. PPC occurred in 29 cases (12.1%). Majority of PPC cases (64%) associated with Salter-Harris II fractures (19 cases), 14% in Salter-Harris III (4), 14% in Salter-Harris IV (4 cases), 8% in triplane fractures (2 cases). No cases of physeal arrest found in Salter-Harris I or Tillaux fractures. Cox multivariate regression analysis revealed statistically significant associations between mechanism of injury and PPC, and between degree of initial displacement and PPC. Each millimeter of initial displacement increased relative risk of PPC by 1.15 (P < 0.01). Although trends suggested possible link between residual displacement after reduction or number of reduction attempts and PPC risk, these correlations were not significant. Conclusions: Recent studies reported higher PPC following distal tibial physeal fractures compared to this cohort. Significant predictors of PPC included extent of initial fracture displacement and mechanism of injury. While trends noted regarding residual displacement and number of reduction attempts, found not significant in predicting PPC.