Kling T F, Bright R W, Hensinger R N
J Bone Joint Surg Am. 1984 Jun;66(5):647-57.
Fractures of the distal end of the tibia in children often involve the physis. They are of particular importance because partial growth arrest can occur and result in angular deformity, limb-length discrepancy, or incongruity of the joint surface (or a combination of these). We evaluated the cases of thirty-two children who had a fracture leading to established partial growth arrest of the distal end of the tibia. Most of this group had had a Salter-Harris Type-III or Type-IV fracture. Twenty-eight of the fractures had been treated by gentle closed reduction and immobilization in a plaster cast. We also evaluated the cases of thirty-three children who were seen by us for treatment of an acute fracture; most of these were Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia. Nineteen of the twenty acute Type-III or Type-IV fractures that were treated with accurate open reduction of the physis and internal fixation healed without growth disturbance, while five of the nine fractures that were treated by closed means formed a bone bridge, presaging a disturbance in growth. This study suggests that Salter-Harris Type-III and Type-IV, and perhaps Type-II, fractures of the distal end of the tibia commonly cause disturbance of growth in the tibia, and that anatomical reduction of the physis by closed or open means may decrease the incidence of these disturbances of growth, including shortening and varus angulation of the ankle.
儿童胫骨远端骨折常累及骨骺。这些骨折尤为重要，因为可能会发生部分生长停滞并导致成角畸形、肢体长度差异或关节面不平整（或这些情况的组合）。我们评估了32例因骨折导致胫骨远端已确定部分生长停滞的儿童病例。该组大多数患儿发生的是Salter-HarrisⅢ型或Ⅳ型骨折。其中28例骨折采用轻柔的闭合复位并石膏固定治疗。我们还评估了33例因急性骨折前来就诊的儿童病例；其中大多数是胫骨远端的Salter-HarrisⅢ型或Ⅳ型骨折。20例急性Ⅲ型或Ⅳ型骨折中，19例采用精确的骨骺切开复位内固定治疗后愈合且无生长障碍，而9例采用闭合方法治疗的骨折中有5例形成了骨桥，预示生长将受到干扰。本研究表明，胫骨远端的Salter-HarrisⅢ型和Ⅳ型骨折，可能还有Ⅱ型骨折，通常会导致胫骨生长紊乱，通过闭合或开放方法对骨骺进行解剖复位可能会降低这些生长紊乱的发生率，包括踝关节缩短和内翻成角。
