Long Leg Versus Short Leg Cast Immobilization for Treatment of Salter-Harris II Distal Tibial Fractures After Closed Reduction: A Multisite Retrospective Study

Abstract

ABSTRACT: Background: Distal tibial physeal fractures are common injuries that can frequently be treated nonoperatively. Most commonly, long leg cast (LLC) immobilization is recommended after closed reduction. The purpose of this study was to compare outcomes between LLC and short leg cast (SLC) immobilization after closed reduction of Salter-Harris II (SH-II) distal tibial fractures. Methods: A retrospective, multicenter comparative study was performed evaluating skeletally immature patients treated with closed reduction of a displaced SH-II distal tibia fracture at 3 level I Pediatric Trauma Centers between 2012 and 2018. Radiographs after casting were compared with those at the time of cast removal to assess the primary study outcome of loss of reduction (LOR). Secondary outcomes included the length of casting, premature physeal closure, time to weightbearing, and time to release to activities. Results: A total of 148 patients with a median age of 12.7 years (interquartile range 11.2-13.7) met the inclusion criteria. LLC were utilized in 110 cases while 38 patients received an SLC. LOR occurred in 10 patients (6.8%), 9 with an LLC and 1 in an SLC (P = .454). Those treated in SLC had a shorter length of casting (P = .030) and quicker release to activities (P = .004) than those with LLC. Conclusions: Findings of this retrospective, multicenter study show similar rates of LOR between SLC and LLC immobilization for SH-II distal tibial fractures after closed reduction. Patients received less total casting and returned to sports quicker after SLC immobilization. Key Concepts: (1) Salter-Harris II (SH-II) distal tibia fractures can be treated with closed reduction and short leg casting without an increased rate of displacement (2) Distal tibial physeal fractures treated in a short leg cast can possibly return to sports quicker (3) The rate of interval displacement of an SH-II distal tibia fracture after closed reduction is approximately 6.7%. Level of Evidence: III, Retrospective Comparative Study

Keywords

• Distal tibial physeal fractures
• Pediatric ankle fractures
• Dias-Tachdjian
• Short leg cast
• Long leg cast
• Salter-Harris II fracture