Fractures of the distal tibial metaphysis in children: patterns of injury and results of treatment.

BACKGROUND

Fractures of the tibia are common in children. Fractures of the distal tibial metaphysis have been only described in fracture texts without reference to a peer-reviewed study. The purpose of the present study was to review this fracture pattern and report the results of treatment.

METHODS

The medical records and radiographs of children seen at our institution with a fracture of the tibia were reviewed. The patients with fractures of the distal tibial metaphysis who had been followed until healing were included. Fractures of the distal tibial diaphysis, toddler's fractures, and pathologic fractures were excluded.

RESULTS

Twenty-six children met these criteria and were included in the study. The mechanism of injury was indirect in 13 fractures and direct in 12 fractures. In 1 patient, the mechanism of injury was unknown. The main cause of indirect injury was fall (11 cases). The most common was the transverse type of fracture (14 patients) followed by the oblique type (11 patients). Only 8 cases were nondisplaced. Valgus angulation was usually associated with a recurvatum deformation, whereas varus angulation was associated with procurvatum angulation. These patterns were present in 14 patients. We observed shorter healing time when the fracture was oblique than transverse. Children with the oblique pattern of injury were younger than children with a transverse fracture.

CONCLUSIONS

The patterns of displacement of the distal tibial metaphyseal fractures reported in our study vary from those presented in textbooks. Distal tibial metaphyseal fractures can present with 2 types of displacement: valgus recurvatum and varus procurvatum. Fractures of the fibula always present with the same pattern as the tibia. Primary union of the distal tibial metaphyseal fracture may be expected in all cases regardless of the type of fracture, age, and gender.