Pediatric Distal Tibia Fractures
synonyms:
Pediatric Distal Tibital Fx ICD-9
- 823.80 (closed fracture of unspecified part of tibia)
- 823.81 (unspecified part, closed, fibula with tibia)
- 823.90 (open fracture of unspecified part ot tibia)
- 823.92 (open unspecified part, fibula with tibia)
Pediatric Distal Tibital Fx Etiology / Epidemiology / Natural History
Pediatric Distal Tibital Fx Anatomy
- Distal tibial growth plate closure starts anteromedially, progresses posteriorly and laterally and finishes anterolaterally.
Pediatric Distal Tibital Fx Clinical Evaluation
- Pain and deformity in the ankle, degree dependent on fracture severity.
- Evaluate skin integrity, swelling, and neurovascular status of the leg/foot.
Pediatric Distal Tibital Fx Xray / Diagnositc Tests
- A/P, lateral and mortise views of the ankle. Appears like a Tillaux fracture on A/P and mortise views.
- CT demonstrates that fracture line does not extend through the anterior cortex.
- MRI generally not indicated although can provide information on ligamentous and physeal injury. (Lohman M, Skeletal Tadiol 2001;30:504).
Pediatric Distal Tibital Fx Classification / Treatment
- Nondisplaced Salter-Harris I: long leg NWB cast for 3 weeks followed by short leg cast, WBAT for 3-4 weeks.
- Displaced Salter Harris I: Closed reduction under general anesthesia with muscle relaxation (decreased risk of iatrogenic physeal injury). Incomplete reduction suggests interposed peristeum which may lead to premature physeal closure required open reduction. (Barmada A, JPO 2003;23:733).
- Nondisplaced Salter-Harris II: long leg NWB cast for 3 weeks followed by short leg cast, WBAT for 3-4 weeks.
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Pediatric Distal Tibital Fx Associated Injuries / Differential Diagnosis
Pediatric Distal Tibital Fx Complications
- Delayed union, nonunion
- Malunion
- Growth arrest
- Arthritis
- Osteonecrosis of the distal tibial epiphysis
- Compartment syndrome
Pediatric Distal Tibital Fx Follow-up Care
- Follow-up xrays every 6 months for 2 years or until skeletal maturity.
Pediatric Distal Tibital Fx Review References
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