title: Transitional fractures of the distal tibia: a minimal access approach for osteosynthesis.
abstract: BACKGROUND
  Transitional fractures typically occur in patients with partially closed growth plates. In case of displacements >2 mm, osteosynthesis is recommended. Open reduction and stabilization with lag screws is the most common approach. Infection and paraesthesia are common complications of this method. This study describes an alternative approach by closed reduction and cannulated screw fixation.
  
  
  METHODS
  All patients with transitional fractures treated by closed reduction and cannulated screw fixation were identified. All patients with >1 year after implant removal were included in this investigation. Of 27 patients treated by this technique, 21 met the inclusion criteria and were sent a standardized questionnaire including the Foot Function Index (FFI). All cases with impairments in the FFI were invited for a follow-up examination.
  
  
  RESULTS
  Postoperative complications occurred in two patients (8.3%): one reported paraesthesia of the hallux and one showed skin irritations above the screw insertion. Average follow-up time was 3.8 years after implant removal. Of 21 patients who returned the questionnaire, three patients (14.3%) had impairment in the FFI and were invited for clinical follow-up: one patient showed mild signs of osteoarthritis without visible gaps of the joint surface, one patient had minimally restricted pronation, and one had neither clinical nor radiologic correlates for the impairment reported. Sports activity was reduced in one patient.
  
  
  CONCLUSIONS
  If closed reduction can be achieved fixation with cannulated screws proved to be a satisfactory method with little scars and good clinical results.
authors.affiliation: Department of Paediatric Surgery, Medical University Graz, Graz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Castellani
authors.forename: Georg
authors.initials: G
authors.lastname: Riedl
authors.forename: Robert
authors.initials: R
authors.lastname: Eberl
authors.forename: Stefan
authors.initials: S
authors.lastname: Grechenig
authors.forename: Annelie-Martina
authors.initials: AM
authors.lastname: Weinberg
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002370:Casts, Surgical; D002648:Child; D004838:Epiphyses / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D015641:Radiography, Interventional; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome