1. In discussing the end results of epiphyseal fractures, each epiphysis must be considered individually.
2. The distal tibial epiphysis is subject to three types of fracture. In the first type, there is little or no damage to the cartilage, and deformity is consequently rare. In the second type, the cartilage is crushed in about 40 per cent. of the cases, with resulting deformity. In the third type, the cartilage is crushed and deformity is to be expected.
3. Malposition of the epiphysis, per se, is not a cause of deformity. As we found in our study of the distal radial epiphysis, any displacement of the epiphysis is corrected by nature within a few months of the date of injury. We believe that in all cases the fracture should be reduced as accurately as possible. However, if complete reduction cannot be obtained, we believe it is wiser to allow Nature to further correct the displacement as she does than to subject these patients to osteotomy.
In summarizing our work on the epiphyses to date, we are convinced that deformity is due only to crushing of the epiphysis at the time of the injury or during osteotomy for correction. If an epiphysis has been so crushed, it is not humanly possible with our present knowledge to prevent the inevitable deformity. If the epiphysis has not been crushed, it will continue to grow normally, although alignment after repeated attempts at reduction may be poor.
(C) 1936 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.