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  • Title: [Proximal tibial epiphyseal separation in adolescents. Apropos of 13 cases with 10 reviewed after 5 years].
    Author: Piétu G, Rogez JM, Letenneur J.
    Journal: Rev Chir Orthop Reparatrice Appar Mot; 1994; 80(5):428-35. PubMed ID: 7746928.
    Abstract:
    INTRODUCTION: The goal of this study was to evaluate the mid-term follow-up of fractures of the proximal tibial epiphysis. MATERIAL AND METHODS: From January 1981 to May 1987, 12 male teenagers sustaining 13 fractures of the proximal tibial epiphysis were treated in our institution. 9 patients totalizing 10 fractures were reviewed with a minimal 5 years follow-up. RESULTS: All knees were painless with a symmetric range of motion except in one case with a 15 degree flexion lag. One case of PCL deficiency was observed. Differences in femoro-tibial angles between both limbs was under 5 degrees in 7 of the 9 patients. In 2 cases, an evolving deformity was noted. Differences in posterior epiphyseal tibial tilt between both knees was over 5 degrees in 2 of the 8 unilateral cases. In 1 surgically treated patient an evolving deformity was noted. Mean tibial length discrepancy (T.L.D.) was over 10 millimeters in 1 case with evolving discrepancy. 3 cases of asymptomatic minimal post traumatic arthritis were noticed. DISCUSSION: In our series, as opposed to most others, Salter-Harris type IV fracture was the most often encountered due to the advanced age of our patients. Unusual cases, such as 2 triplane fractures and Salter-Harris type II avulsion fracture, were present. Lateral ligament insufficiency was noted in case of varus malalignement of the fractured limb. Due to the advanced age of our patients, no major T.L.D. was noted, but frontal or sagittal malalignement occurred in half of the unilateral cases, 50 per cent of which were proved to be evolutive. Arthritic remodeling was noticed only in cases of Salter-Harris type IV when aggravated by limb malalignement. CONCLUSION: Fractures of the proximal tibial epiphysis are mainly encountered in late adolescence with an unusual proportion of Salter-Harris type III and IV fractures. In spite of their advanced age, these patients are at high risk for limb malalignement which can increase. We have noted the incidence of arthritic remodeling in Salter-Harris type IV fracture. A longer follow-up is needed to determine if these changes will have clinical relevance.
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