Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children

Authors

  • Antti Stenroos Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Hospital
  • Jussi Kosola Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Hospital
  • Jani Puhakka 1 Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Hospital
  • Topi Laaksonen Department of Pediatric Orthopedics and Traumatology, Helsinki New Children’s Hospital; Finland
  • Matti Ahonen Department of Pediatric Orthopedics and Traumatology, Helsinki New Children’s Hospital; Finland
  • Yrjänä Nietosvaara Department of Pediatric Orthopedics and Traumatology, Helsinki New Children’s Hospital; Finland

DOI:

https://doi.org/10.1080/17453674.2019.1643632

Abstract

Background and purpose — Unnecessary radiographic and clinical follow-ups are common in treatment of pediatric fractures. We hypothesized that follow-up radiographs are unnecessary to monitor union of physeal fractures of the distal tibia.

Patients and methods — All 224 (147 boys) children under 16 years old treated for a physeal fracture of the distal tibia during a 5-year period (2010–14) in Helsinki Children’s Hospital were included in this study. Peterson type II fractures comprised 55% and transitional fractures (Tillaux and Triplane) 20% of all injuries. Fracture displacement and alignment was measured. Type and place of treatment
was recorded. Number of follow-up radiographs and outpatient visits was calculated and their clinical significance was assessed.

Results — 109 children had fractures with < 2 mm displacement and no angulation. The other 115 children’s mean fracture displacement was 6 mm (2–28). 54% of all children were treated by casting in situ in the emergency room, 20% with manipulation under anesthesia and 26% with surgery (internal 57, external fixation 2). Median 3 (1–7) follow-up appointments and median 3 (0–6) radiographs were taken. Follow-up radiographs at or before cast removal did not alter treatment in any of the patients. 223 patients’ fractures healed within 4–9 weeks in good alignment (≤ 5° angulation).

Interpretation — Routine radiographic follow-up is unnecessary to monitor alignment and union of physeal fractures of the distal tibia.

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Published

2019-07-22

How to Cite

Stenroos, A., Kosola, J., Puhakka, J., Laaksonen, T., Ahonen, M., & Nietosvaara, Y. (2019). Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children. Acta Orthopaedica, 90(6), 610–613. https://doi.org/10.1080/17453674.2019.1643632