J Korean Orthop Assoc.  2008 Dec;43(6):672-676.

Factors Influencing Premature Physeal Closure following Physeal Injury of the Ankle in Children

• Kim JR
• Song KH

Abstract

PURPOSE: To evaluate the factors influencing premature physeal closure (PPC) following physeal fractures of the ankle in children.
MATERIALS AND METHODS
Forty-eight children with physeal injuries of the ankle were analyzed retrospectively after a minimum follow-up of 1 year. We undertook statistical analysis according to age, gender, cause, fracture type, mechanism of injury, and treatment methods for incidence of PPC.
RESULTS
Ten fractures (28.3%) were complicated by PPC. There were three cases of leg length discrepancy (LLD) more than 2 cm, five cases of angulation with LLD more than 2 cm, and two cases of fibula shortening. There were no correlation between PPC and age, sex, cause, or injury mechanism (p>0.05). There was a statistically significant correlation between the rate of PPC and treatment methods (p=0.018).
CONCLUSION
Operative treatment may decrease the frequency of PPC in some fractures. Regardless of treatment method, we recommend anatomic reduction to decrease the risk of PPC.

Keyword

Children; Ankle; Physeal injuries; Premature physeal closure

MeSH Terms

Animals
Ankle
Child
Fibula
Follow-Up Studies
Humans
Incidence
Leg
Retrospective Studies

Figure

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  Fig. 1 A 11-year-old girl left distal tibia physeal injury was treated with closed reduction and cast. (A) Preoperative anteroposterior radiograph shows Salter-Harris type II physeal injury of distal tibia and fibular fracture. (B) Postcast radiograph shows undisplaced distal tibial physeal fracture but distance of medical physis is increased. (C) Radiographs at 3 years after closed reduction shows 3 cm shortening of the left tibia and 10o varus angulation of the left ankle joint. (D, E) Angulation correction and lengthening with Ilizarov apparatus was done.

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  Fig. 2 A 7 year-year-old boy sustained physeal injuries of the left ankle. (A) Preoperative radiographs show Salter-Harris type I physeal injury of the left distal tibia and fibula. (B) Postoperative radiograph after closed reduction and percutaneous pinning for distal tibia and closed reduction for distal fibular physeal fracture. (C) At postoperative 5 years, the radiographs show fibular shortening due to premature physeal closure of the distal fibular physis.

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