Clinical Outcome after Surgical Treatment of Transitional Fractures of the Distal Tibia in Children

PURPOSE OF THE STUDY Fractures affecting a partially closed physis are described as transitional fractures. The distal tibia is one of the most common locations for transitional fractures second only to the distal radius. Aim of this retrospective study was to evaluate the clinical and radiological results after surgical treatment of transitional fractures of the distal tibia. PATIENTS AND METHODS From May 2003 to March 2009 24 children (median age 14 years) received surgical treatment for transitional fractures of the distal tibia. 89% (21/24) of patients were followed up after 27.5 (range 6 to 72) months to assess functional outcome (using the AO Foot and Ankle Score). RESULTS Nine girls and 15 boys were included in the study with the girls being younger on average (12.4 +/- 0.9 vs. 14.3 +/- 1.1 years, p = 0.00013). Two-plane fractures were present in 4 cases, 15 and 5 children sustained tri-plane I and II fractures, respectively. Median preoperative fracture displacement was measured at 4 mm (range 3 to 11 mm). Traumatic supination of the ankle joint during sports activities was the predominant injury mechanism (18/24 cases) followed by bicycle or motorbike accidents (6/24). A satisfactory reduction (1 mm or less) was achieved in all but one patient. In this case revision surgery was necessary to restore anatomical reduction. No perioperative complications occurred in the remaining 23 cases. Metal implants were removed upon fracture consolidation after 8.2 +/- 6.7 months. At the time of follow-up none of the children were impaired in activities of daily living and there were no restrictions in sporting activity. All patients scored good or excellent results on the AO Foot and Ankle Score. DISCUSSION Surgical stabilization can be recommended as a safe and effective treatment strategy in displaced transitional fractures of the distal tibia and will lead to good or excellent mid term results.