Mid- and long-term outcomes of surgical treatment for distal tibial physeal fractures

Kart, Hayati; Jabbarli, Agshin; G�ndo�du, Mert; Tun�, Oytun Derya; Topkar, Osman Mert; Baysal, �zg�r; Akg�lle, Ahmet Hamdi

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Mid- and long-term outcomes of surgical treatment for distal tibial physeal fractures [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2025; 31(2): 189-193 | DOI: 10.14744/tjtes.2024.06474

Mid- and long-term outcomes of surgical treatment for distal tibial physeal fractures

Hayati Kart¹, Agshin Jabbarli², Mert G�ndo�du², Oytun Derya Tun�², Osman Mert Topkar², �zg�r Baysal², Ahmet Hamdi Akg�lle²
¹Department of Orthopaedic Surgery and Traumatology, �stanbul Medeniyet University G�ztepe Training and Research Hospital, �stanbul, Türkiye
²Department of Orthopaedic Surgery and Traumatology, Marmara University Pendik Training and Research Hospital, �stanbul, Türkiye

BACKGROUND: Distal tibial fractures are among the most common injuries in childhood. The treatment of distal tibial physeal
fractures presents significant challenges for orthopedic surgeons, and potential complications are a major concern. The aim of this
study is to evaluate the mid- and long-term outcomes of patients who underwent surgery for a distal tibial physeal fracture.
METHODS: This retrospective study included 46 patients who underwent surgery for a distal tibial physeal fracture between 2008
and 2022. Patients were evaluated based on the trauma that caused the fracture, the type of fracture (Salter-Harris classification), the
type of reduction performed (open or closed), the type of implant used (K-wire or cannulated screw), the location of the fracture in
the joint (intra-articular or extra-articular), and the presence of complications. The American Orthopaedic Foot and Ankle Society
(AOFAS) score was used for clinical assessment.
RESULTS: The median age of the patients was 12 years (interquartile range [IQR] 10-14). The median follow-up time was 67 months
(IQR 50.5-107). Postoperative anatomical reduction was achieved in 45 patients (97.8%), while 1 patient (2.2%) failed to achieve anatomical
reduction. The median AOFAS score for all patients was 100 (IQR 90-100). Patients treated with K-wire fixation had a median
score of 90 (IQR 86.5), while those treated with cannulated screws had a median score of 100 (IQR 92.5-100). Although the score for
cannulated screws was statistically significantly higher (p=0.024), both groups demonstrated excellent clinical outcomes.
CONCLUSION: Distal tibial physeal fractures are one of the most common childhood fractures and can lead to severe complications.
The mid- and long-term outcomes of surgical treatment of distal tibial physeal fractures are favorable. The method of reduction
(open or closed), the choice of implant (K-wire or cannulated screw), and the location of the fracture (intra-articular or extra-articular)
do not affect outcomes or complications in patients with these injuries. The crucial factor in the treatment of distal tibial physeal
fractures is achieving anatomical reduction.

Keywords: Ankle, distal tibial physeal fracture, premature physeal closure.

Distal tibia fiz k�r�klar�n�n cerrahi tedavisinin orta ve uzun d�nem sonu�lar�

Hayati Kart¹, Agshin Jabbarli², Mert G�ndo�du², Oytun Derya Tun�², Osman Mert Topkar², �zg�r Baysal², Ahmet Hamdi Akg�lle²
¹�stanbul Medeniyet �niversitesi G�ztepe E�itim ve Ara�t�rma Hastanesi, Ortopedi ve Travmatoloji Anabilimdal�, �stanbul,T�rkiye
²Marmara �niversitesi Pendik E�itim ve Ara�t�rma Hastanesi, Ortopedi ve Travmatoloji Anabilimdal�, �stanbul,T�rkiye

AMA�: Distal tibia k�r�klar� �ocukluk �a��nda en s�k g�rülen yaralanmalar aras�ndad�r. Distal tibia kemik k�r�klar�n�n tedavisi ortopedik cerrahlar i�in
ikilemlerle dolu zorlu bir süre�tir. Potansiyel komplikasyonlar da fizis k�r�klar� ile ilgili ciddi bir endi�e kayna��d�r. Bu �al��man�n amac� distal tibia fizis
k�r�� nedeniyle ameliyat edilen hastalar�n orta ve uzun d�nem sonu�lar�n� de�erlendirmektir.
GERE� VE Y�NTEM: �al��mam�z 2008 ile 2022 y�llar� aras�nda distal tibial fizis k�r�� nedeniyle ameliyat edilen 46 hasta ile retrospektif olarak
ger�ekle�tirildi. Hastalar k�r��a neden olan travmalar�, k�r�k tipi (Salter-Harris), redüksiyon tipi (a��k/kapal�), kullan�lan implant tipi (K-teli/kanüle
vida), k�r��n eklem i�indeki yeri (eklem i�i veya d��) ve komplikasyon varl�� a��s�ndan de�erlendirildi. Hastalar�n klinik de�erlendirmesinde AOFAS
skoru kullan�ld�.
BULGULAR: �al��maya dahil edilen hastalar�n medyan ya�� 12 y�ld� (IQR 10-14). Medyan takip süresi 67 ayd� (IQR 50.5-107). Ameliyat sonras� 45
(%97.8) hastada anatomik redüksiyon sa�lan�rken, 1 (%2.2) hastada anatomik redüksiyon sa�lanamad�. Tüm hastalar i�in medyan AOFAS skoru 100
(IQR 90-100) idi. K-teli fiksasyonu yap�lan hastalar�n medyan AOFAS skoru 90 (IQR 86.5) iken, kanüllü vida kullan�lan hastalar�n medyan AOFAS
skoru 100 (IQR 92.5-100) idi. Kanüle vida kullan�lan hastalar�n AOFAS skoru istatistiksel olarak anlaml� derecede daha yüksek olmas�na ra�men
(p=0,024), her iki grupta da mükemmel klinik sonu�lar elde edilmi�tir.
SONU�: Distal tibia fizis k�r�klar�, ciddi komplikasyonlara neden olabilen yayg�n �ocukluk �a�� k�r�klar�ndan biridir. Distal tibia fizis k�r�klar�n�n cerrahi
tedavisinin orta ve uzun d�nem sonu�lar� iyidir. Redüksiyon y�ntemi (a��k veya kapal�), implant se�imi (K-teli veya kanüllü vida) ve k�r��n yerle�imi
(eklem i�i veya eklem d��) bu yaralanmalara sahip hastalarda sonu�lar ve komplikasyonlar üzerinde etkili de�ildir. Distal tibial fizis k�r�klar�n�n tedavisinde
en �nemli fakt�r anatomik redüksiyonun sa�lanmas�d�r.

Anahtar Kelimeler: Ayak bile�i, distal tibia fiz k�r��, erken fiz kapanmas�

Corresponding Author: Hayati Kart, T�rkiye
Manuscript Language: English

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