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With any fracture involving the joint surface, there is a risk of future arthritis in that joint. With any fracture involving the growth plate, there is a risk of growth arrest. The majority of fractures heal well and the outcome is excellent. Any concern should prompt immediate return to ED for evaluation. Provide parents with " Caring for your child in a leg cast" and warning signs of a tight cast: increased pain despite analgesia, change in toes - colour, perfusion, increased swelling. There is a risk of compartment syndrome with the cast. The child should remain non-weight bearing until instructed by orthopaedics. Isolated distal fibula physeal fractures should be followed up in fracture clinic in 7-10 days with repeat x-ray.įor undisplaced distal tibial physeal fractures, follow-up in fracture clinic should occur within 7 days with a repeat x-ray.įor displaced distal tibia physeal fractures managed with closed reduction and immobilisation should be reviewed in fracture clinic within 5 days.įor tillaux and triplane fractures < 2mm displacement, these can be followed up in 7 days. There is also a fracture of the distal shaft of the fibula.įigure 6: A) X-ray showing tillaux fracture (2 mm displacement Salter-Harris type III distal tibia fractureįigure 5: Sixteen year old boy with a Salter-Harris type III fracture of the distal tibia.Due to poor alignment, a screw was inserted across the fracture site. This was initially managed with closed reduction. Salter-Harris type II distal tibia fractureįigure 4: Displaced Salter-Harris type II distal tibia fracture with associated fibula fracture.It is usually diagnosed clinically with localised tenderness above the distal fibula. The only radiographic finding may be soft tissue swelling over the distal fibular physis. In a Salter-Harris type I fracture, the fracture may not be evident on x-ray. Salter-Harris type I distal tibia fracture.If a tillaux or triplane fracture is suspected, discuss with orthopaedics for need to order a CT scan. What radiological investigations should be ordered?ĪP, lateral and mortise views of the ankle should be ordered. Tenderness will be located directly over the lateral malleolus rather than at the lateral ligamentsĥ. They are often misdiagnosed as an ankle sprain or are missed. Salter-Harris type I distal fibula fractures are the most common ankle fractures. The patient will not want to weight bear. The patient will present with a painful, swollen ankle. These injuries commonly occur from a torsional or twisting mechanism about the ankle. How common are they and how do they occur? The distal tibia is the third most common physis to be injured. These injuries account for 25% of all physeal injuries. 3) Sagittal ( anteroposterior AP) plane - within the epiphysis and extending into the joint. 2) Coronal plane - through the posterior metaphysis. 1) Transverse (horizontal) plane - through the growth plate. Triplane (Figure 3) - a Salter-Harris type IV fracture, which occurs in three planes (sagittal, transverse and coronal)įigure 1: Closure of the distal tibial physis begins 1) centrally, followed by 2) medial closure and then 3) lateral closure.įigure 3: In a triplane fracture, the fracture line occurs in three planes.Tillaux fracture (Figure 2) - a Salter-Harris type III fracture involving avulsion of the anterolateral corner of the distal tibial epiphysis (the last portion of the physis to close).They can also be classified by the mechanism or direction of force applied to the injured ankle.ĭue to the asymmetrical closure of the distal tibial physis (Figure 1) during early adolescence, transitional fractures can also occur. Typically requires operative managementĭistal tibial physeal fractures are classified by the Salter-Harris classification. Tillaux and triplane fracture 2 mm displacement If treated operatively, to be arranged by orthopaedic service If treated with closed reduction, fracture clinic within 5 days If reduction not anatomic, discuss with orthopaedic on call serviceįor Salter-Harris type III and IV, refer to orthopaedic on call service Immobilise in above-knee cast, non-weight bearingįor Salter-Harris type III and IV, discuss with orthopaedic on call service whether CT scan is required to confirm that fracture is truly undisplacedĬlosed reduction with above-knee cast, non-weight bearing. Isolated undisplaced distal fibula physeal - Salter-Harris type I and IIįracture clinic within 7-10 days with x-ray What are the potential complications associated with this injury?.What is the usual ED management for this injury?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?.See also: Distal tibia and or fibular physeal fracture