Fractures of the distal tibial physis

Injuries around the ankle in children can result in fractures that primarily involve the growth plate: the weakest area of the developing distal tibia. The morphology of the fracture varies depending on age and mechanism of injury. Unique fracture patterns occur due to the complex interplay of anatomy and physiology, and asymmetric closure of this physis near skeletal maturity produces a unique subset of injuries called transitional fractures. The method of treatment can be controversial and depends upon the fracture type and age of the patient. Detailed imaging is essential for decision making, particularly when surgical intervention is required. Operative strategies must be mindful of the need to preserve remaining growth and prevent deformity. Growth disturbance and deformity are common and must be monitored. Several strategies for dealing with premature physeal closure are available but decisions are based on careful planning and individualized to the patient and their carers.