Residual angulation of distal tibial diaphyseal fractures in children younger than ten years

Background: The purpose of this study was to evaluate the factors that influence residual angulation after treating pediatric distal tibial diaphyseal fractures. Methods: 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 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). Early postoperative and late follow-up radiographs were used to measure angulation. Results: Twenty-four patients had valgus angulations >5 degrees at the final follow-up. There was no varus, or anteroposterior residual angulations >5 degrees. There was more residual valgus angulation when the postoperative angulation was >5 degrees (p = 0.006) and when intramedullary nail and external fixators were applied for treatment (p = 0.004). 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. Conclusions: Valgus angulation after pediatric distal tibial fractures persisted in this study sample. Accurate reduction should be performed to prevent residual deformity.