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Physeal Fractures of the Distal Tibia and Fibula (Salter-Harris Type I, II, III, and IV Fractures)

Podeszwa, David A. MD*; Mubarak, Scott J. MD

Journal of Pediatric Orthopaedics: June 2012 - Volume 32 - Issue - p S62–S68
doi: 10.1097/BPO.0b013e318254c7e5
Trauma Supplement

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.

*Department of Orthopaedic Surgery, Children’s Medical Center Dallas and Texas Scottish Rite Hospital for Children, Dallas, TX

Rady’s Children’s Hospital, San Diego, CA

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprint: David A. Podeszwa, MD, Department of Orthopaedic Surgery, Children’s Medical Center Dallas, 1935 Medical District Dr., E2300 Dallas, TX 75235. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.