Evaluation of factors affecting development of complications in the early surgical treatment of distal tibial epiphyseal fractures.

Objectives: This study aims to investigate the relationships among factors affecting complication development and premature physeal closure (PPC) in patients undergoing surgical treatment within 12 h of the time of injury.

Patients and methods: Between January 2015 and January 2021, a total of 46 patients (37 males, 9 females; mean age: 11.9±2.5 years; range, 6 to 16 years) who were operated within 12 h due to displacement >2 mm after reduction were retrospectively analyzed. Demographics, fracture type (Salter-Harris [SH]), fracture mechanism (Dias & Tachdjian [DT]), accompanying fibula fracture, and initial displacement were assessed with preoperative radiographs. At two years of follow-up, PPC, angular deformity, and length discrepancy were evaluated.

Results: Of the patients, PPC was observed in 21.7%. Angular deformity and length discrepancy were noted in 6.5% of cases. The average initial displacement was 6.8 mm, with no significant correlation between displacement and complications (p>0.05). While the rates of PPC varied by fracture type, there was no statistically significant relationship between fracture types and the development of complications (p>0.05). Premature physeal closure was more common in fractures caused by the supination-plantar flexion (SPF) mechanism (60%) compared to the pronation-eversion external rotation (PEER) mechanism (5.3%) (p=0.018). Angular deformity and length discrepancy were only associated with SH type 3 and 4 fractures. Although fibular fractures accompanied 25% of distal tibial epiphyseal fractures, their presence did not show a significant correlation with complications (p>0.05).

Conclusion: Our study findings indicate that factors previously thought to influence the development of complications may be insufficient to predict PPC occurrence in distal tibial epiphyseal fractures, once anatomical reduction is achieved within 12 h. As the preoperative delay shortens, the impact of fracture-related factors on complication development may reduce.