Open versus closed treatment of distal tibia physeal fractures: a systematic review and meta-analysis

  • Waleed A. Asad
  • Manaf H. S. Younis
  • Abdulaziz F. Ahmed
  • Talal Ibrahim
Original Article • ANKLE - FRACTURES



Distal tibia physeal fractures can lead to growth complications such as premature physeal closure (PPC), angular deformity and leg length discrepancy. The aim of our study was to systematically review the literature to assess whether open reduction and internal fixation (ORIF) is associated with lower rates of PPC compared to closed treatment.

Materials and methods

We searched several databases from 1966 to 2016 for studies that evaluated ORIF versus closed treatment of distal tibia physeal fractures. We performed a meta-analysis using a random effects model to pool odds ratios (OR) for the comparison of PPC rate between children undergoing ORIF versus closed treatment. We also investigated the PPC rate in Salter–Harris (S–H) type I and II fractures. Descriptive, quantitative and qualitative data were extracted.


Out of the 253 articles identified, six retrospective cohort studies were eligible, with a total of 970 distal tibia physeal fractures. The pooled OR of PPC between ORIF and closed treatment showed no statistically significant difference [OR = 0.98, 95% confidence interval (CI) 0.48, 1.97; I 2 = 49.8%, p = 0.076]. No significant difference in the rate of PPC was detected in S–H type I and II fractures with ORIF and closed treatment [OR = 1.25, 95% CI 0.72, 2.16; I 2 = 32.1%, p = 0.22].


The cumulative evidence at present does not indicate an association between the method of treatment of distal tibia physeal fractures and the risk of PPC. Both treatment types are feasible, but less surgical-related complications are associated with closed treatment.

Level of evidence



Distal tibia Physeal Fracture Open reduction Closed reduction Treatment 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  1. 1.Department of Surgery, Section of OrthopedicsHamad General HospitalDohaQatar

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