title: Physeal fractures of the distal tibia and fibula (Salter-Harris Type I, II, III, and IV fractures).
abstract: Physeal fractures of the distal tibia and fibula are common and can be seen at any age, although most are seen in the adolescent. An understanding of the unique anatomy of the skeletally immature ankle in relation to the mechanism of injury will help one understand the injury patterns seen in this population. A thorough clinical exam is critical to the diagnosis and treatment of these injuries and the avoidance of potentially catastrophic complications. Nondisplaced physeal fractures of the distal tibia and fibula can be safely treated nonoperatively. Displaced fractures should undergo a gentle reduction with appropriate anesthesia while multiple reduction attempts should be avoided. Gapping of the physis >3 mm after reduction should raise the suspicion of entrapped periosteum that will increase the risk of premature physeal closure. Open reduction of displaced Salter-Harris type III and IV fractures is critical to maintain joint congruity and minimize the risk of physeal arrest.
authors.affiliation: Department of Orthopaedic Surgery, Children's Medical Center Dallas and Texas Scottish Rite Hospital for Children, Dallas, TX 75235, USA. david.podeszwa@childrens.com
authors.forename: David A
authors.initials: DA
authors.lastname: Podeszwa
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Mubarak
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology*; D005260:Female; D005360:Fibula / Q000293:injuries*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006132:Growth Plate / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D018570:Risk Assessment; D000072042:Salter-Harris Fractures; D013978:Tibial Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*