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What is the best treatment for displaced Salter-Harris II physeal fractures of the distal tibia?

 Hoon Park  ;  Dong Hoon Lee  ;  Seung Hwan Han  ;  Sungmin Kim  ;  Nam Kyu Eom  ;  Hyun Woo Kim 
 Acta Orthopaedica, Vol.89(1) : 108-112, 2018 
Journal Title
 Acta Orthopaedica 
Issue Date
Adolescent ; Child ; Preschool Child ; Closed Fracture Reduction/adverse effects/statistics & numerical data ; Female ; Humans ; Male ; Open Fracture Reduction/adverse effects/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Tibial Fractures/pathology/surgery/*therapy ; Treatment Failure
Background and purpose - The optimal treatment of displaced Salter-Harris (SH) II fractures of the distal tibia is controversial. We compared the outcomes of operative and nonoperative treatment of SH II distal tibial fractures with residual gap of >3 mm. Factors that may be associated with the incidence of premature physeal closure (PPC) were analyzed. Patients and methods - We retrospectively reviewed 95 patients who were treated for SH II distal tibial fractures with residual gap of >3 mm after closed reduction. Patients were assigned to 1 of 2 groups: Group 1 included 25 patients with nonoperative treatment, irrespective of size of residual gap (patients treated primarily at other hospitals). Group 2 included 70 patients with operative treatment. All patients were followed for >/= 12 months after surgery, with a mean follow-up time of 21 months. Logistic regression analyses were performed to identify risk factors for the occurrence of PPC. Results - The incidence of PPC in patients who received nonoperative treatment was 13/52, whereas PPC incidence in patients who received operative treatment was 24/70 (p = 0.1). Multivariable logistic regression analysis determined that significant risk factors for the occurrence of PPC were age at injury, and injury mechanism. The method of treatment, sex, presence of fibular fracture, residual displacement after closed reduction, and implant type were not predictive factors for the occurrence of PPC. Interpretation - Operative treatment for displaced SH II distal tibial fractures did not seem to reduce the incidence of PPC compared with nonoperative treatment. We cannot exclude that surgery may be of value in younger children with pronation-abduction or pronation-external rotation injuries.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Min(김성민)
Kim, Hyun Woo(김현우) ORCID logo https://orcid.org/0000-0001-8576-1877
Park, Hoon(박훈) ORCID logo https://orcid.org/0000-0002-8063-3742
Eom, Nam Kyu(엄남규)
Lee, Dong Hoon(이동훈)
Han, Seung Hwan(한승환) ORCID logo https://orcid.org/0000-0002-7975-6067
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