Results of proximal metaphyseal fractures in children

Background.

The aims of the present study were: determining the extent of the two typical outcomes (valgus deformity and leg overgrowth); examining the extent, limits and duration of possible spontaneous corrections; and analysing the consequences of different types of therapy.

Methods. Metaphyseal tibial fractures in children are rare (incidence 5.6:100,000). Seven children were retrospectively re-examined by their medical records and roentgenograms. The patients' ages at the time of the accident ranged from 1 year 10 months to 10 years 2 months, and the average observation period was 34 months.

Results. All the patients experienced a subjective recovery, with the exception of one child who had minor functional problems. All of them were able to move their knee joint freely. Six patients developed a genu valgum (proximal tibia angle between 6° and 16°); each of them was treated conservatively. Only two patients – both under the age of 5 – experienced a partial spontaneous correction. Overgrowth on the side of the fracture was observed in four cases, varying from 0.5 cm to 1.5 cm, most pronounced after complete reduction and stable osteosynthesis.

Conclusions. We recommend surgical correction and osteosynthesis as the preferred method of treatment, even with the increased likelihood of overgrowth. This is based on our observation of valgus deformity occurring in all cases after conservative treatment, with partial remodelling seen only in children up to the age of 5.