Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children
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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Copyright (c) 2019 Antti Stenroos, Jussi Kosola, Jani Puhakka, Topi Laaksonen, Matti Ahonen, Yrjänä Nietosvaara
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