![]() In skeletally immature patients, there is femur overgrowth after mid-diaphyseal fracture similarly, in patients under ten years old, there may be increased valgus angulation of the tibia after injury. Cozen investigated valgus deformities after proximal tibial fractures in children. The remodeling process in such injuries is complicated because of the activity of the muscles in the anterior and lateral compartments of the lower leg and the decreased growth potential of the distal tibia compared to that of the proximal tibia. However, tibial angular deformities, especially distal tibial fractures, are less favorable injuries with regard to remodeling. In general, axial malalignments will remodel in children after forearm or femoral shaft fractures. The physis responds to such malalignment by differential growth, which aligns the shaft perpendicular to the major joint reaction forces. If there is any residual angulation after bone union, there is spontaneous correction. Children's bones remodel in response to the normal stresses of body weight, muscle action, joint reaction forces, and intrinsic control mechanisms including the periosteum. This dynamic remodeling makes the anatomic reduction less significant in a child than it is in a comparable injury in an adult. The normal process of bone remodeling in the diaphysis and metaphysis of a growing child may realign initially malunited fragments. Accurate reduction should be performed to prevent residual deformity. ![]() Valgus angulation after pediatric distal tibial fractures persisted in this study sample. Multivariate logistic regression analysis showed that postoperative angulation (adjusted odds ratio (OR) 4.33, 95% confidence interval (CI) 1.07–17.53) and treatment methods (intramedullary nail: adjusted OR 7.33, 95% CI 1.31–41.07 external fixator: adjusted OR 11.35, 95% CI 1.91–67.40 compared with the cast group) were associated with residual deformity. There was more residual valgus angulation when the postoperative angulation was >5° ( p = 0.006) and when intramedullary nail and external fixators were applied for treatment ( p = 0.004). ![]() There was no varus, or anteroposterior residual angulations >5°. Twenty-four patients had valgus angulations >5° at the final follow-up. Early postoperative and late follow-up radiographs were used to measure angulation. The mean patient age was 6.8 ± 2.3 years, and the mean follow-up duration was 4.1 ± 1.3 years (range, 3 to 6 years). We retrospectively reviewed the records of 75 children under the age of ten who were treated at two referral centers for distal tibial diaphyseal fractures. The purpose of this study was to evaluate the factors that influence residual angulation after treating pediatric distal tibial diaphyseal fractures. ![]()
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