Résumé
The physis of a long bone may get 'sandwiched' and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radiologically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample 'breathing space' to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technique used by us.
Résumé
Either proximal tibial or tibial physeal injuries are rare. The combination of both is even rarer, let alone causes a vascular injury. Early intervention is the key for management. We hereby present an interesting case of simultaneous proximal tibiofibular physeal injury with popliteal arterial occlusion and common peroneal nerve injury. The present case is important in two aspects: firstly it reports a very rare occurrence of simultaneous proximal tibiofibular physeal injury associated with vascular insult and common peroneal nerve injury; secondly it highlights that with timely intervention excellent results can be achieved in paediatric patients.