The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 1983
Salter-Harris Type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus.
Salter-Harris Type-IV fractures of the epiphysis extend through the articular cartilage, epiphysis, physis, and metaphysis and have a high rate of complications secondary to premature partial closure of the physis. In this study we attempted to determine which Type-IV fractures of the distal end of the tibia result in premature partial closure, how the various treatment modalities affect the risk of premature physeal closure, and how the complication itself might be best managed. Thirty-two Type-IV fractures of the distal end of the tibia were seen at the Mayo Clinic during a five-year period. ⋯ A physeal bar was best detected by tomograms made in two planes and by scanograms. Bar formation may be treated by excision of the bar, arrest of the whole physis, osteotomy, or combinations of these procedures. Of the thirteen patients with a triplane fracture and the one with a Type-IV fracture of the lateral part of the plafond, all fourteen were near maturity at the time of injury, and no growth-arrest problems developed.