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Proximal Tibial Physeal Injury
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Contents
Other Names
- Proximal Tibial Physeal Injury
- Proximal Tibial Physeal Fracture
- Proximal Tibia Epiphyseal Fractures
Background
- This page refers to proximal tibial epiphyseal and physeal fractures seen in pediatric patients
History
Epidemiology
- Account for less than 1% of all pediatric fractures[1]
- Peak incidence between 10 and 16 years old[2]
Introduction
Stress induced chronic salter harris 1 growth plate fracture of the proximal tibia[3]
General
- Rare fracture pattern seen in skeletally immature patients
- Diagnosis can be made with standard radiographs
- Note: Can mimic knee dislocation, develop peroneal nerve or popliteal injuries
Mechanism of Injury
- About 50% of these occur in sporting events
- Often due to indirect injury with hyperextension force on the knee
- Example is emergent breaking of a bicycle with leg in hyperextension, forcefully striking the ground with forward momentum
- Less commonly, high energy direct trauma such as being struck by a car bumper
Associated Conditions
- Tibial Tubercle Avulsion Fracture
- Can co-occur with a type III tibial tubercle fracture
- Popliteal Artery Injury (5%)
- Peroneal Nerve Injury (5%)
- Ligamentous injuries
- Seen in up to 40% of salter harris III, IV injuries (need citation)
- Acute Compartment Syndrome
Risk Factors
- Unknown
Differential Diagnosis
Differential Diagnosis Knee Pain
- Fractures
- Dislocations & Subluxations
- Patellar Dislocation (and subluxation)
- Knee Dislocation
- Proximal Tibiofibular Joint Dislocation
- Muscle and Tendon Injuries
- Ligament Pathology
- Arthropathies
- Bursopathies
- Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
- Neuropathies
- Other
- Bakers Cyst (Popliteal Cyst)
- Patellar Contusion
- Pediatric Considerations
- Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
- Patellar Pole Avulsion Fracture
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
- Proximal Tibial Metaphyseal Fracture
- Proximal Tibial Physeal Injury
Clinical Features
History
- Inability to bear weight following injury
Physical Exam: Physical Exam Knee
- Pain, swelling
- Tenderness along the physis
- Visible deformity or palpable step off if displaced
- Carefully evaluate for varus and valgus instability
- Though neurovascular exam
Evaluation
Coronal view of knee CT showing salter harris II fracture of the proximal tibial epiphysis[4]
Radiographs
- Standard Radiographs Knee
- Sufficient to make the diagnosis
- Findings
- Displacement of fracture fragments
- Use salter harris classification
CT
- Can help better assess fracture displacement
- Especially useful for SH III, IV fractures
- Consider obtaining ABIs since proximal tibial physeal injuries can mimic knee dislocation
- Can reduce the need for unnecessary CTs in pedaitric patients
Classification
- Follows the Salter Harris Classification
Management
Nonoperative
- Indications
- Nondisplaced fractures (< 2mm)
- Stable SH type I, II fractures
- Reduce with traction, gentle flexion
- Long Leg Cast
- In slight flexion for 6 weeks
Operative
- Indications
- Unstable SH I, II fractures
- Redisplacement following closed treatment
- Irreducible fractures
- Displaced SH III, IV fractures
- Vascular injuries
- Technique
- CRPP
- ORIF
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Prognosis and Complications
Prognosis
- Needs to be updated
Complications
- Mimic of Knee Dislocation
- Can have peroneal nerve or popliteal injuries
- Occurs in about 7% of cases[5]
- Acute Compartment Syndrome
- Loss of reduction
- Following closed reduction, non op management
- Growth disturbance
- Leg length discrepancy or angular deformities
- More common in open fractures
- Ligamentous instability
See Also
Internal
- Knee Pain (Main)
- Knee Anatomy (Main)
- Physical Exam Knee
- Pediatric Fractures (Main)
- Apophyseal And Epiphyseal Injuries (Main)
External
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
References
- ↑ Little, Rhianna M., and Matthew D. Milewski. "Physeal fractures about the knee." Current reviews in musculoskeletal medicine 9 (2016): 478-486.
- ↑ Mubarak, Scott J., et al. "Classification of proximal tibial fractures in children." Journal of children's orthopaedics 3.3 (2009): 191-197.
- ↑ Nanni, M., et al. "Stress-induced Salter-Harris I growth plate injury of the proximal tibia: first report." Skeletal radiology 34 (2005): 405-410.
- ↑ Image courtesy of orthobullets, "proximal tibial epiphyseal injury
- ↑ Guled, Uday, et al. "Proximal tibial and fibular physeal fracture causing popliteal artery injury and peroneal nerve injury: A case report and review of literature." Chinese Journal of Traumatology 18.04 (2015): 238-240.
Created by:
John Kiel on 22 March 2023 15:26:26
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Last edited:
22 March 2023 16:16:31
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