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Mubarak SJ, Kim JR, Edmonds EW, et al. Classification of proximal tibial fractures in children. J Child Orthop. 2009;3(3):191-7doi: 10.1007/s11832-009-0167-8.
Mubarak, S. J., Kim, J. R., Edmonds, E. W., Pring, M. E., & Bastrom, T. P. (2009). Classification of proximal tibial fractures in children. Journal of children's orthopaedics, 3(3), 191-7. https://doi.org/10.1007/s11832-009-0167-8
Mubarak, Scott J, et al. "Classification of proximal tibial fractures in children." Journal of children's orthopaedics vol. 3,3 (2009): 191-7. doi: https://doi.org/10.1007/s11832-009-0167-8
Mubarak SJ, Kim JR, Edmonds EW, Pring ME, Bastrom TP. Classification of proximal tibial fractures in children. J Child Orthop. 2009 Jun;3(3):191-7. doi: 10.1007/s11832-009-0167-8. Epub 2009 Mar 17. PMID: 19308478; PMCID: PMC2686808.
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J Child Orthop. 2009 Jun;3(3):191-7. doi: 10.1007/s11832-009-0167-8. Epub 2009 Mar 17.

Classification of proximal tibial fractures in children.

Journal of children's orthopaedics

Scott J Mubarak, Jung Ryul Kim, Eric W Edmonds, Maya E Pring, Tracey P Bastrom

Affiliations

  1. Pediatric Orthopedics and Scoliosis Division, Rady Children's Hospital and Health Center, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA, [email protected].

PMID: 19308478 PMCID: PMC2686808 DOI: 10.1007/s11832-009-0167-8

Abstract

PURPOSE: To develop a classification system for all proximal tibial fractures in children that accounts for force of injury and fracture patterns.

METHODS: At our institution, 135 pediatric proximal tibia fractures were treated from 1997 to 2005. Fractures were classified into four groups according to the direction of force of injury: valgus, varus, extension, and flexion-avulsion. Each group was subdivided into metaphyseal and physeal type by fracture location and Salter-Harris classification. Also included were tibial tuberosity and tibial spine fractures.

RESULTS: Of the 135 fractures, 30 (22.2%) were classified as flexion group, 60 (44.4%) extension group, 28 (20.8%) valgus group, and 17 (12.6%) varus group. The most common type was extension-epiphyseal-intra-articular-tibial spine in 52 fractures (38.5%). This study shows that proximal tibial fractures are age-dependent in relation to: mechanism, location, and Salter-Harris type. In prepubescent children (ages 4-9 years), varus and valgus forces were the predominate mechanism of fracture creation. During the years nearing adolescence (around ages 10-12 years), a fracture mechanism involving extension forces predominated. With pubescence (after age 13 years), the flexion-avulsion pattern is most commonly seen. Furthermore, metaphyseal fractures predominated in the youngest population (ages 3-6 years), with tibial spine fractures occurring at age 10, Salter-Harris type I and II fractures at age 12, and Salter-Harris type III and IV physeal injuries occurring around age 14 years.

CONCLUSION: We propose a new classification scheme that reflects both the direction of force and fracture pattern that appears to be age-dependent. A better understanding of injury patterns based on the age of the child, in conjunction with appropriate pre-operative imaging studies, such as computer-aided tomography, will facilitate the operative treatment of these often complex fractures.

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