Outcome of Open Distal Tibial Physeal Fractures: A Descriptive Report of Two Cases

Open distal tibial physeal injuries are rare but clinically significant due to their proximity to the ankle joint and the potential impact on future growth in skeletally immature patients. These injuries pose unique challenges, including a higher risk of delayed healing, premature physeal closure, infection, and long-term deformity. We report two pediatric cases of open Salter-Harris type II distal tibial physeal fractures associated with Gustilo-Anderson type III soft-tissue injuries. Both patients underwent urgent debridement, stabilization with K-wire fixation, and multidisciplinary soft-tissue management. At the two-year follow-up, fracture union and infection control were achieved in both cases; however, medial physeal closure occurred, resulting in mild coronal plane deformity. These cases emphasize the importance of prompt debridement, careful physeal handling, multidisciplinary soft-tissue coverage, and long-term surveillance for growth disturbances.