Closure of the Anterior Portion of the Upper Tibial Epiphysis as a Complication of Tibial-Shaft Fracture

Closure of the epiphyseal plate as a result of direct injury to growimig cells, although not common, is not an unusual feature of skeletal trauma iii children. We recently encountered two patients in whom asymmetrical closure of the uppem-tibial epiphysis occurred following fracture of the distal third of the tibial shaft without apparent injury to the epiphysis. The epiphyses affected closed prematurely, resulting in progressive hyperextension deformity of the knee. A search of the litema-ture revealed only one similar case, which was reported by Smillie in 1951. CASE 1. M. L. \., an eleven-year-old girl, was struck by an automobile at 3:00 i’.mt. on July 27, 1958. The car wheel ran over her right leg in such a way that she suffered an open COmfliilluted fracture of the lower third of the shafts of the right tibia and fibula (Fig. 1-A). There was tmo other injury apart from multiple contusions and abrasions, none of which involved the region of tile right knee. Tetanus toxoid and penicillin were administered and the child was taketl to tile operating room where, at 9:30 P.M., the wound was debrided and closed. The fracture was reduced, using:t Kirschner wire in the calcaneus, and a toe-to-groin plaster-of-Paris cast was applied.