Surgical management of proximal tibial epiphyseal fracture in children

Abstract

Background Fractures of the proximal tibial physis require a significant amount of force, and therefore, these injuries account for less than 1% of all physeal separations. The proximal tibial physis has intrinsic varus–valgus and side-to-side translational stability because of the collateral ligaments and the lateral fibular buttress. Purpose The aim was to evaluate operative treatment of children who have proximal tibial epiphyseal fracture (indications, techniques, advantage, disadvantages, complications, and results). Patients and methods From December 2015 to February 2018, a prospective case series study was performed at Al Mataria Teaching Hospital and Al-Hussein University Hospital. A total of 20 patients with proximal epiphyseal fractures were admitted and treated. Results The mean operative time was 54±22.45 min (range: 25–90 min), with average intraoperative blood loss of 25 ml (range: 20–30 ml). The method of fixation changes according to the type of fixation. K-wire accounts for ∼75%, whereas cannulated screw 4.5 accounts for ∼25% in the physeal group. In the tubercle group, cannulated screw 4.5 accounts for ∼50%, cannulated 4.5+ tension band accounts for ∼25%, and K-wire accounts for ∼25%. Conclusion Fractures of the proximal tibial epiphysis are rare, and the potential complications in this young population are limb threatening. Constant monitoring of neurovascular status is essential to identify acute and delayed compromise. A low tolerance should be taken in to account to use supplementary fixation, such as K-wires, in view of the difficulty in maintaining the reduction and the potential for poor outcomes should this be lost.