Clinical Evaluation of Treatment Adopted for Proximal Tibial Epiphyseal Fractures in Children Aged Below 14 Years in a Tertiary Care Hospital

Background: Proximal Tibial epiphyseal fractures are rare and they make up less than 01% of all epiphyseal (growth plate) separations. These fractures require significant force and occur in a region with intrinsic stability due to the surrounding structures; collateral ligaments and fibular buttress. Aim of the Study: To evaluate the operative treatment for children with proximal Tibial epiphyseal fractures, with the objectives of enumerating the Indications for surgery, surgical techniques adopted, Advantages and disadvantages, Possible complications and Overall results. Materials: A prospective case series study was conducted between December 2022 and January 2024 at Al Viswabharathi Medical College and General Hospital, Kurnool, Andhra Pradesh. 23 children with proximal Tibial epiphyseal fractures were included. Treatment method adopted was surgical intervention with various fixation methods. Results: The mean operative time was 59.25±17.45 minutes, with a range from 36 to 93 minutes. The mean intra-operative blood loss was 36.25 mL (range: 23.15 to 36.50 mL). Fixation methods used were ‘K’ wires in epiphyseal group-75% of the children; cannulated screws were used in remaining 25% of the children. In the tubercle group, fixation was more varied: 50% had 4.5 mm cannulated screws and 25% had a combination of 4.5 mm cannulated screws and tension band 25% had K-wires. Conclusion: Proximal tibial epiphyseal fractures are uncommon but potentially serious due to the risk of limb-threatening complications. Close monitoring of neurovascular status is crucial to detect any acute or delayed complications. There is a low tolerance for failure in maintaining the reduction after fixation, especially when using K-wires, which may require supplementary fixation to ensure the best outcome.