Presentation
Footballer. Game clash.
Patient Data
Distal tibia fracture with displacement between the epiphysis and metaphysis (Type II Salter-Harris). There is also spiral fracture of the distal fibula. The Salter-Harris type II injury starts as a horizontal separation (like type I) but this is completed by exiting through the metaphysis, resulting in a triangular fragment which varies in size.
Postoperative control
External fixation with Kirschner wire is to stabilize the fractured bone.
Medially and centrally the tibial growth plate has started to close.
Control after removing external fixation with Kirschner wire. Distal tibial physeal growth arrest affecting the central and medial portion of the physis. Laterally distal tibia there is lamellar periosteal reaction.
Case Discussion
The complication following a physeal injury is growth plate arrest, which can be treated conservatively and operatively ( excision of the bone bridge, leg lengthening, contra and ipsilateral epiphysiodesis, corrective osteotomies).
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