Epiphyseal fractures of the proximal tibia
Introduction
Epi- and apophyseal fractures of the proximal tibia are, despite the fact that trauma of the knee occurs frequently, very rare. The literature gives an incidence of 0.5–3% (of all epiphyseal fractures). They mostly occur in older children and adolescents [1], [2], [3].
In younger children direct trauma from traffic accidents is the most frequent cause of an epiphyseal fracture. Apophyseal fractures mostly occur during sport activities like basketball, where excessive pressure tears the apophyses apart [3], [4], [5].
Both fractures can be difficult to diagnose. Clinical features are the inability to lift the leg because of pain and/or a haematoma. A haemarthrosis may be present. There is tenderness at the epiphysis and soft tissue-swelling in the proximal lower leg. X-rays in stress and an X-ray of the unaffected leg will help to establish the diagnosis if the dislocation is minimal. Apophyseal fractures should be distinguised from the Osgood-Schlatter lesion, in which only the anterior part of the tuberosity is affected [3].
The nature of the fracture requires anatomical reduction. Closed reduction can be difficult, necessitating open reduction with fixation by a screw or K-wires [1], [4], [6], [7].
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Patients and methods
We performed a retrospective analysis of all children with proximal tibial epiphyseal fractures seen between 1982–1998 in the paediatric surgical department of our hospital. Patients with epiphysiolysis as well as those with apophysiolysis were included. We investigated the following data: sex, age, trauma mechanism, classification according to Salter-Harris (Fig. 1) Ogden, Tross and Murphy (Fig. 2), method of treatment and final result. The follow up period was 6 months (range 6 to 12 months).
Results
Ten patients, aged 10–15 yr were analysed of whom six had been treated for an epiphyseal fracture and four for an apophyseal fracture. Data on the six patients with epiphyseal fractures are listed in Table 1. The fractures were mostly the result of direct trauma from traffic accidents. One patient was treated without reposition and fixation. Two patients were treated by closed reduction under general anaesthesia. Two fractures required open reduction and screw fixation. The last required
Discussion
Fractures of the proximal tibia are extremely rare in children. There are two types of fracture; the epiphyseal and the apophyseal. The standard method of categorisation is Salter-Harris for epiphyseal fractures and Ogden, Tross and Murphy for apophyseal fractures.[6], [8] In younger children epiphyseal fractures are often the result of direct force on the lower leg and are therefore often seen in traffic accidents. In adolescents this fracture is the result of a forced extension with a flexed
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