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Original article

Vol. 155 No. 5 (2025)

Demographic distribution and injury patterns of ankle physeal fractures in children: a retrospective cohort study

Cite this as:
Swiss Med Wkly. 2025;155:4265
Published
16.05.2025

Summary

INTRODUCTION: Ankle physeal fractures are a significant concern in paediatric populations due to their potential to cause growth disturbances, including premature physeal closure. The present study aimed to describe the epidemiology and injury patterns of ankle physeal fractures in children treated at a single university hospital centre in Switzerland over a 19-year period.

MATERIALS AND METHODS: This retrospective cohort study included children aged 0 to 16 years who were admitted to our institution for an ankle physeal fracture between January 2004 and April 2023. Demographic and radiological data were collected, and fractures were classified according to the Salter-Harris and Dias-Tachdjian classifications. Statistical analyses, including Fisher’s exact test, were performed for dichotomous outcomes, with significance set at p<0.05.

RESULTS: We included 259 patients with a mean age of 12.3 years old, mostly males (58.7%), with most fractures occurring among boys aged 14 and girls aged 12. Sports-related activities accounted for 51% of fractures, with the highest incidence in autumn. Isolated fractures of the distal tibia were most common (47.1%), and Salter-Harris type II fractures represented 51% of cases (p <0.05). The predominant mechanism of injury was supination–plantar flexion (33.6%).

CONCLUSION: This study provided a comprehensive overview of the distribution and patterns of paediatric ankle physeal fractures. It underscored the need for future prospective multicentre studies to explore causative factors and outcomes related to growth disturbances. Targeted prevention and management strategies may help mitigate the incidence and consequences of these injuries.

References

  1. Podeszwa DA, Mubarak SJ. Physeal fractures of the distal tibia and fibula (Salter-Harris Type I, II, III, and IV Fractures). Journal of Pediatric Orthopaedics. 2012;32(SUPPL. 1).
  2. Langenskiöld A. Traumatic premature closure of the distal tibial epiphyseal plate. Acta Orthop Scand. 1967;38(4):520–31. doi: https://doi.org/10.3109/17453676708989658
  3. Wuerz TH, Gurd DP. Pediatric physeal ankle fracture. J Am Acad Orthop Surg. 2013 Apr;21(4):234–44. doi: https://doi.org/10.5435/JAAOS-21-04-234
  4. Mizuta T, Benson WM, Foster BK, Paterson DC, Morris LL. Statistical analysis of the incidence of physeal injuries. J Pediatr Orthop. 1987;7(5):518–23. doi: https://doi.org/10.1097/01241398-198709000-00003
  5. Peterson CA, Peterson HA. Analysis of the incidence of injuries to the epiphyseal growth plate. J Trauma. 1972 Apr;12(4):275–81. doi: https://doi.org/10.1097/00005373-197204000-00002
  6. Peterson HA, Madhok R, Benson JT, Ilstrup DM, Melton LJ 3rd. Physeal fractures: Part 1. epidemiology in Olmsted County, Minnesota, 1979-1988. J Pediatr Orthop. 1994;14(4):423–30. doi: https://doi.org/10.1097/01241398-199407000-00002
  7. Ogden JA. Injury to the growth mechanisms of the immature skeleton. Skeletal Radiol. 1981;6(4):237–53. doi: https://doi.org/10.1007/BF00347197
  8. Fuchs JR, Gibly RF, Erickson CB, Thomas SM, Hadley Miller N, Payne KA. Analysis of Physeal Fractures from the United States National Trauma Data Bank. Children (Basel). 2022 Jun;9(6):914. doi: https://doi.org/10.3390/children9060914
  9. Gibly RF, Georgopoulos G, Carry PM, Miller NH. Lower extremity physeal fractures and post-traumatic surgical deformities; National Trauma Data Bank and institutional cohorts. J Clin Orthop Trauma. 2022 Mar;27:101827. doi: https://doi.org/10.1016/j.jcot.2022.101827
  10. Barmada A, Gaynor T, Mubarak SJ. Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor. J Pediatr Orthop. 2003;23(6):733–9. doi: https://doi.org/10.1097/01241398-200311000-00010
  11. Blondin E, Stourbe O, Plancq MC, Deroussen F, Gouron R, Klein C. Outcomes of pediatric distal tibial physeal fractures. Orthop Traumatol Surg Res. 2022 Oct;108(6):103199. doi: https://doi.org/10.1016/j.otsr.2022.103199
  12. Nenopoulos SP, Papavasiliou VA, Papavasiliou AV. Outcome of physeal and epiphyseal injuries of the distal tibia with intra-articular involvement. J Pediatr Orthop. 2005;25(4):518–22. doi: https://doi.org/10.1097/01.bpo.0000158782.29979.14
  13. Rohmiller MT, Gaynor TP, Pawelek J, Mubarak SJ. Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure? J Pediatr Orthop. 2006;26(3):322–8. doi: https://doi.org/10.1097/01.bpo.0000217714.80233.0b
  14. Salter RB, Harris WR. Injuries Involving the Epiphyseal Plate. J Bone Joint Surg Am. 1963;45(3):587–622. doi: https://doi.org/10.2106/00004623-196345030-00019
  15. Dias LS, Tachdjian MO. Physeal injuries of the ankle in children: classification. Clin Orthop Relat Res. 1978;(136). doi: https://doi.org/10.1097/00003086-197810000-00032
  16. Goldberg VM, Aadalen R. Distal tibial epiphyseal injuries: the role of athletics in 53 cases. Am J Sports Med. 1978;6(5):263–8. doi: https://doi.org/10.1177/036354657800600507
  17. Landin LA, Danielsson LG. Children’s ankle fractures. Classification and epidemiology. Acta Orthop Scand. 1983 Aug;54(4):634–40. doi: https://doi.org/10.3109/17453678308992902
  18. Kärrholm J, Hansson LI, Svensson K. Prediction of growth pattern after ankle fractures in children. J Pediatr Orthop. 1983 Jul;3(3):319–25. doi: https://doi.org/10.1097/01241398-198307000-00009
  19. Spiegel PG, Cooperman DR, Laros GS. Epiphyseal fractures of the distal ends of the tibia and fibula. A retrospective study of two hundred and thirty-seven cases in children. J Bone Joint Surg Am. 1978 Dec;60(8):1046–50. doi: https://doi.org/10.2106/00004623-197860080-00004
  20. Cottalorda J, Béranger V, Louahem D, Camilleri JP, Launay F, Diméglio A, et al. Salter-Harris Type III and IV medial malleolar fractures: growth arrest: is it a fate? A retrospective study of 48 cases with open reduction. J Pediatr Orthop. 2008 Sep;28(6):652–5. doi: https://doi.org/10.1097/BPO.0b013e318182f74c
  21. Russo F, Moor MA, Mubarak SJ, Pennock AT. Salter-Harris II fractures of the distal tibia: does surgical management reduce the risk of premature physeal closure? J Pediatr Orthop. 2013;33(5):524–9. doi: https://doi.org/10.1097/BPO.0b013e3182880279
  22. Fong DT, Man CY, Yung PS, Cheung SY, Chan KM. Sport-related ankle injuries attending an accident and emergency department. Injury. 2008 Oct;39(10):1222–7. doi: https://doi.org/10.1016/j.injury.2008.02.032
  23. D’Angelo F, Solarino G, Tanas D, Zani A, Cherubino P, Moretti B. Outcome of distal tibia physeal fractures: a review of cases as related to risk factors. Injury. 2017 Oct;48 Suppl 3:S7–11. doi: https://doi.org/10.1016/S0020-1383(17)30650-2
  24. Steiger C, De Marco G, Cuérel C, Tabard-Fougère A, Chargui M, Dayer R, et al. A retrospective epidemiological cohort study of ankle fractures in children and teenagers. J Child Orthop. 2023 Jun;17(4):348–53. doi: https://doi.org/10.1177/18632521231182424
  25. Jung HS, Park MS, Lee KM, Choi KJ, Choi WY, Sung KH. Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents. Injury. 2021 Apr;52(4):844–8. doi: https://doi.org/10.1016/j.injury.2021.01.014
  26. Tartaglione JP, Rosenbaum AJ, Abousayed M, DiPreta JA. Classifications in Brief: Lauge-Hansen Classification of Ankle Fractures. Clin Orthop Relat Res. 2015 Oct;473(10):3323–8. doi: https://doi.org/10.1007/s11999-015-4306-x
  27. Sferopoulos NK. Bone bruising of the distal forearm and wrist in children. Injury. 2009 Jun;40(6):631–7. doi: https://doi.org/10.1016/j.injury.2009.01.104