Greenstick fractures of the proximal metaphyseal tibia: a retrospective multicenter study on the outcome after non-surgical or surgical treatment and the occurrence of posttraumatic tibia valga.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors have no conflicts of interest or financial ties to disclosure. 4. J Child Orthop. 2009 Jun;3(3):191-7. doi: 10.1007/s11832-009-0167-8. Epub 2009 Mar 17. Classification of proximal tibial fractures in children. Mubarak SJ(1), Kim JR, Edmonds EW, Pring ME, Bastrom TP. Author information: (1)Pediatric Orthopedics and Scoliosis Division, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA, pedsortho@chsd.org. PURPOSE: To develop a classification system for all proximal tibial fractures in children that accounts for force of injury and fracture patterns. METHODS: At our institution, 135 pediatric proximal tibia fractures were treated from 1997 to 2005. Fractures were classified into four groups according to the direction of force of injury: valgus, varus, extension, and flexion-avulsion. Each group was subdivided into metaphyseal and physeal type by fracture location and Salter-Harris classification. Also included were tibial tuberosity and tibial spine fractures. RESULTS: Of the 135 fractures, 30 (22.2%) were classified as flexion group, 60 (44.4%) extension group, 28 (20.8%) valgus group, and 17 (12.6%) varus group. The most common type was extension-epiphyseal-intra-articular-tibial spine in 52 fractures (38.5%). This study shows that proximal tibial fractures are age-dependent in relation to: mechanism, location, and Salter-Harris type. In prepubescent children (ages 4-9 years), varus and valgus forces were the predominate mechanism of fracture creation. During the years nearing adolescence (around ages 10-12 years), a fracture mechanism involving extension forces predominated. With pubescence (after age 13 years), the flexion-avulsion pattern is most commonly seen. Furthermore, metaphyseal fractures predominated in the youngest population (ages 3-6 years), with tibial spine fractures occurring at age 10, Salter-Harris type I and II fractures at age 12, and Salter-Harris type III and IV physeal injuries occurring around age 14 years. CONCLUSION: We propose a new classification scheme that reflects both the direction of force and fracture pattern that appears to be age-dependent. A better understanding of injury patterns based on the age of the child, in conjunction with appropriate pre-operative imaging studies, such as computer-aided tomography, will facilitate the operative treatment of these often complex fractures. DOI: 10.1007/s11832-009-0167-8 PMCID: PMC2686808