Clinical, radiographic and pedobarographic analysis of skeletally immature patients with surgically treated distal metaphyseal fractures of the tibia: is concomitant fixation of the fibula necessary?

Abstract

This study evaluated the outcomes of distal tibia metaphyseal fractures (DTMFs) managed surgically and compared the outcomes of patients with and without associated fibula fracture fixation. Thirty-two consecutive patients (14 males; mean age at the time of injury: 7.8 years) with closed displaced DTMFs, with (22 patients; group A) or without associated fibula fractures fixation (10 patients; group B), were included. Besides standard radiographic measurements, the following static and dynamic pedobarographic parameters were evaluated: foot total static plantar pressure percentage (PP%tot), static plantar pressure percentage of the forefoot (PP%ff) and of the rear foot (PP%rf), landing sequence of the metatarsals during contact with the ground (MTland), and impulse percentage of the metatarsal heads (MT%imp) and the medial and lateral heel (MH%imp and LH%imp). All patients were followed for at least 2 years (range: 2–4.5 years). Functional outcomes were excellent to good in all but two patients (93.8%) at the last follow-up visit using the Johner-Wruths criteria’. Radiographic measurements, PP%tot, PP%ff, PP%rf, MT%imp, MH%imp and LH%imp were not significantly different between two groups as well as between injured and uninjured side of patients within the same group (P > 0.05). Abnormal MTland sequence was found in 40.9% of group A (9/22) and in 40% of group B patients (4/10) (P > 0.05). Stabilization of associated fibula fractures did not significantly impact the clinical, radiographic and pedobarographic outcomes of the children with displaced DTMFs who were surgically treated. Level of evidence: Level III.