Conservative versus surgical treatment in management of salter-harris type II distal tibial physeal fractures

Twenty-one patients with Salter-Harris type II physeal fractures of the ankle were treated, either conservatively or operatively, according to the indication for the different types of mechanism of injury. All patients were evaluated and followed clinically and radiologically for an average of 15 months. There were 15 males and 6 females. The average age at injury was 9 years and 6 months, whereas the average age at follow-up was11 years. Thirteen patients were treated conservatively by closed reduction, while eight were treated operatively by open reduction and internal fixation. There were no nonunion or arthritis. There was one case of clinically insignificant premature physeal closure. The overall results were good or excellent in 100% of cases and excellent in 86% of cases. There was significant relation between mechanism of injury type and line of treatment. We think that closed reduction should be attempted in every case of Salter-Harris type II physeal fractures of distal tibia with good results, and operative treatment with open reduction and internal fixation could be reserved to cases of irreducible or incompletely reduced fractures, and we found that most of the cases of distal tibial physeal fractures of pronation-eversion external rotation, injury type, needs surgical management