Injuries to the Distal Tibial Epiphyseal Growth Plate: Classification, Treatment and Prognosis

  • M. Carbone
  • S. Boero


Injury to the tibio-tarsal region in childhood presents particular features which form the basis of this chapter on traumatology in the young. The ligamento-capsular complex is relatively robust in children, and therefore acute ligament injuries causing instability do not occur frequently, whereas minor distortions of the distal tibia are more commonplace, do not present any particular difficulty in either diagnosis or treatment and heal well. In a child’s ankle joint, the weakest position where injury damage is most likely consists of the tibial and fibular distal epiphyseal connective cartilage where displacements may occur [1].


Epiphyseal Plate Bone Bridge Malleolar Fracture Ossification Nucleus Epiphyseal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dias LS, Giegerich CR (1983) Fractures of the distal tibial epiphysis in adolescence. J Bone Joint Surg Am 65:438–444PubMedGoogle Scholar
  2. 2.
    Köhler A, Zimmer EA (1970) Limiti del normale ed inizio del patologico nella dia-gnostica radiologica dello scheletro. Ambrosiana, MilanoGoogle Scholar
  3. 3.
    MacNealy GA, Rogers LF, Hernandez R, Poznanski AK (1982) Injuries of the distal tibial epiphysis: systematic radiographic evaluation. Am J Roentgenol 138(4):683–689Google Scholar
  4. 4.
    Ogden JA, Lee J (1990) Accessory ossification patterns and injuries of the malleoli. J Pediatr Orthop 10:306–316PubMedCrossRefGoogle Scholar
  5. 5.
    Salter RB, Harris R (1963) Injuries involving the epiphyseal plate. J Bone Joint Surg Am 45:587–622Google Scholar
  6. 6.
    Onimus M (1990) Les fractures de la cheville. In: Clavert JM, Metaizeau JP (eds) Les fractures des membres chez l’enfant. Sauramps, Montpellier, pp 357–368Google Scholar
  7. 7.
    Marmor L (1970) An unusual fracture of the tibial epiphysis. Clin Orthop 73:132–135PubMedGoogle Scholar
  8. 8.
    Von Laer L (1985) Classification, diagnosis and treatment of transitional fractures of the distal part of the tibia. J Bone Joint Surg Am 67:687–698Google Scholar
  9. 9.
    Khouri N, Ducloyer Ph, Carlioz H (1989) Fractures triplane de la cheville. Rev Chir Orthop 75:394–404PubMedGoogle Scholar
  10. 10.
    Crenshaw AH (1965) Injuries of the distal tibial epiphysis. Clin Orthop 41:98–107PubMedGoogle Scholar
  11. 11.
    Mastragostino S, Carbone M, Origo C (1991) La traumatologia degli arti e della colonna vertebrale in età pediatrica. In: Tamisani AM, Magillo P (eds) Gli infortuni in età pediatrica. Proceedings of the 1st Meeting “La traumatologia degli arti e della colonna celebrale”, Genova, pp 34–46Google Scholar
  12. 12.
    Rockwood CA, Wilkins KE, King RE (1991) Fractures in children, Vol 3. Lippincott, PhiladelphiaGoogle Scholar
  13. 13.
    Leitch JM, Cundy PJ, Paterson DC (1989) Three-dimensional imaging of a juvenile Tillaux fracture. J Pediatr Orthop 9:602–603PubMedCrossRefGoogle Scholar
  14. 14.
    Mastragostino S, Stella G, Scarsi M et al (1992) Lesioni ossee traumatiche della tibiotarsica in età evolutiva. Minerva Ortop Traumatol 43:183–188Google Scholar
  15. 15.
    Grace DL (1983) Irreducible fracture-separations of the distal tibial epiphysis. J Bone Joint Surg Br 65:160–162PubMedGoogle Scholar
  16. 16.
    Kling TF, Bright RW, Hensinger RN (1984) Distal tibial physeal fractures in children that may require open reduction. J Bone Joint Surg Am 66:647–657PubMedGoogle Scholar
  17. 17.
    Kling TF (1990) Operative treatment of ankle fractures in children. Orthop Clin North Am 21:381–392PubMedGoogle Scholar
  18. 18.
    Carbone M, Boero S, Scarsi M, Stella G (1992) Le lesioni ossee traumatiche della tibio-tarsica in età pediatrica. Chirurgia del piede 16:355–358Google Scholar
  19. 19.
    Filipe G (1990) Sequelles des fractures du cou-de-pied de l’enfant. In: Clavert JM, Metaizeau JP (eds) Les fractures des membres chez l’enfant. Sauramps, Montpellier, pp 369–376Google Scholar
  20. 20.
    Kärrholm J, Hansson LI, Selvik G (1984) Changes in tibiofibular relationships due to growth disturbances after ankle fractures in children. J Bone Joint Surg Am 66:1198–1210PubMedGoogle Scholar
  21. 21.
    Bright RW (1974) Operative correction of partial epiphyseal plate closure by osseous-bridge resection and silicone-rubber implant. J Bone Joint Surg Am 56:655–664PubMedGoogle Scholar
  22. 22.
    Langenskiöld A (1975) An operation for partial closure of an epiphyseal plate in children, and its experimental basis. J Bone Joint Surg Br 57:325–330PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • M. Carbone
    • 1
  • S. Boero
    • 1
  1. 1.Divisione di Ortopedia e TraumatologiaIstituto Scientifico G. GasliniGenovaItaly

Personalised recommendations