Clinical and radiological outcomes of pediatric distal tibial physeal fractures: a retrospective analyses from a single institution

Pediatric physeal fractures of the distal tibia are a complex and clinically significant subset of pediatric orthopedic injuries. In this study, we aimed to determine the incidence of physeal pathologies and their correlation with fracture patterns, treatment methods, and patient age within a substantial patient cohort. Prospectively recorded medical charts of 54 children who were followed for an average of 6.1 (range, 3-11.5) years were retrospectively evaluated. Thirty-one (57%) patients had sustained Salter-Harris type 1 and 2 fractures, seven had type 3 fractures, and 16 (27%) had simple or triplane type 4 fractures. Thirty-eight (70%) of the patients underwent surgery. Premature physeal closure (PPC) was detected in 14 (26%) patients. American Orthopedic Foot and Ankle Society scores were good and excellent in 52 (96%) patients and moderate in 2 (3.8%) patients. The patients who experienced PPC were significantly younger at the time of injury, with a mean age of 10.3 ± 3 years, compared to 11.9 ± 2.3 years for those who did not sustain PPC (P = 0.04). In addition, the time to union was significantly longer for patients who experienced PPC (P = 0.03). The mean time to union was 51.7 ± 42.2 days (ranging from 30 to 160 days) for patients with PPC, while it was 36.7 ± 9.9 days (ranging from 25 to 70 days) for those without PPC. Delayed union and younger age at the time of injury are associated with an increased risk of PPC. However, PPC does not significantly impact clinical outcomes during mid-term follow-ups.