Growth disturbances of the distal tibia after physeal separation - What do we know, what do we believe we know? A review of current literature

Purpose: Although they are the most frequent physeal separations of the lower limb, epiphyseal separations (Salter I and II) of the distal tibia are rare injuries, peaking in adolescence. Generally they are considered lobe benign fractures with a low rate of complications. However, in the literature, concrete statements on the incidence of fracture-associated growth disturbances are infrequent and inconsistent, even contradictory. Materials and Methods: A review of textbooks, classical references and recent literature was performed to identify the available evidence on distal tibia physeal separations. Results: A review of the literature showed that most authors agree that conservative, nonoperative treatment is the preferred treatment. But opinions differ on almost all essential fundamentals of treatment. Neither the potential for growth-associated spontaneous correction of posttraumatic axis deviations nor the tolerable degree of axial deviations are evaluated homogenously. Opinions also vary greatly concerning the frequency of posttraumatic growth disturbances, the influence of the mechanism of injury and the amount of primary axial deviation. The most consistent statement in the literature is that poor results of both closed and open reduction lead to an increasing number of growth disturbances, which may include the assumption that not only trauma but operative procedures, too, can be the reason for restrictive physeal plate disturbances. Conclusions: There are two major deficiencies in most of the reviewed literature. The first is that the numbers of cases reported in each article are low due to the rarity of the injury. The second deficiency is that many studies report "physeal injuries" but do not clearly distinguish physeal separations (Salter I and II) from epiphyseal fractures (Salter III and IV) and transitional fractures, all involving the physeal plate, but in completely different ways with completely different prognoses. A prospective multicenter study is taking place.