The frequency of PPC is reported to be between 25% and 67%. 6, 7 If this physis is damaged by a fracture, then premature physeal closure (PPC), or growth arrest, may occur. The distal tibial physis contributes between 3 mm and 5 mm of length to the leg each year, accounting for up to 45% of tibial growth, and 20% of overall leg length. 2, 5 The mean age of these injuries is 12.5 years, and almost all occur in patients aged over eight years. 1- 3 The Salter-Harris II (SHII) 4 fracture is the most common type of physeal injury in the tibia, accounting for over 50% of distal tibial physeal injuries. The Outcomes of Displaced Distal tibial fractures: Surgery Or Casts in KidS (ODD SOCKS) trial, funded by the National Institute for Health and Care Research, aims to provide this high-quality research in order to answer this question, which has been identified as a top-five research priority by the British Society for Children’s Orthopaedic Surgery.Ĭite this article: Bone Joint J 2023 105-B(5):471–473.įractures of the distal tibial physis are estimated to account for up to 40% of all physeal injuries in children. Systematic review and meta-analysis has concluded that high-quality prospective multicentre research is needed to answer this question. A state of clinical equipoise exists regarding whether displaced distal tibial Salter-Harris II fractures in children should be treated with surgery to achieve anatomical reduction, or whether cast treatment alone will lead to a satisfactory outcome. Current literature is of poor methodological quality and is contradictory as to whether conservative or surgical management is superior in avoiding complications and adverse outcomes. Treatment primarily aims to restore alignment and prevent premature physeal closure, as this can lead to angular deformity, limb length difference, or both. Salter-Harris II fractures of the distal tibia affect children frequently, and when they are displaced present a treatment dilemma.
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