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March 5, 2026

A Retrospective Analysis of the Correlation Between Periosteal Entrapment and Growth Disturbances in Salter-Harris II Physeal Fractures of the Distal Tibia in Children

HZHengheng ZhangQinghai University MYMing YangXi'an Honghui Hospital XTXing TongXi'an Honghui Hospital

Key Points

This analysis explores whether periosteal entrapment is an independent risk factor for growth disturbances in Salter-Harris II physeal fractures of the distal tibia.
Conducted a retrospective analysis of 27 patients with distal tibial Salter-Harris II fractures and confirmed periosteal entrapment.
Assessed treatment methods including conservative treatment, closed reduction with percutaneous fixation, and open reduction internal fixation.
Evaluated functional outcomes using the American Orthopaedic Foot and Ankle Society questionnaire.
Analyzed correlations and risk factors using univariable and multivariable regression.
Growth disturbances occurred in 14.8% of patients, but differences among treatment groups were not significant (P > 0.05).
No independent risk factors for growth disturbances were found in either univariable or multivariable analyses (all P > 0.05).
All fractures healed successfully and achieved excellent AOFAS scores (100%) at 6 months postinjury.
The only premature physeal closure occurred in the open reduction internal fixation group, resulting in an ankle valgus deformity.

Abstract

Background: Periosteal entrapment (PE) in displaced distal tibial Salter-Harris (S-H) II fractures is considered a risk for growth disturbances, but causality is debated. Questions/Purposes: To investigate whether PE is an independent risk factor for growth disturbances in distal tibial S-H II physeal fractures and to compare the clinical efficacy of different treatment methods. Patients and Methods: Retrospective analysis of 27 patients (2015 to 2024) with distal tibial S-H II fractures and confirmed PE magnetic resonance imaging (MRI): n=21; follow-up radiograph: n=6. Patients received conservative treatment, closed reduction and percutaneous fixation (CR-PF), or open reduction internal fixation (ORIF). Functional outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire. Correlations (phi coefficient) and risk factors (univariable/multivariable regression) were assessed between PE and growth disturbances. Results: Patients (19 boys and 8 girls; mean age 9.99 y or younger) were followed for a mean of 22.13 months. Overall incidence of growth disturbances was 14.8%, and the difference in the proportion of growth disturbances among the 3 groups was not significant ( P >0.05). No independent risk factors were identified in univariable or multivariable analysis (all P >0.05). All fractures healed, and all groups showed an excellent AOFAS score (100%) at 6 months postinjury and comparable functional recovery (all P >0.05). The only case of premature physeal closure (PPC) occurred in the ORIF group, with the bony bridge appearing at the distal tibial Kump’s bump, subsequently leading to an ankle valgus deformity. Conclusion: PE is not independently correlated with growth disturbances following distal tibia SH II fractures, challenging the traditional mainstream view of its causal role in causing growth disturbances. In addition, the therapeutic effects of different treatment methods are comparable. Conservative treatment should be preferred when closed reduction achieves good alignment, and routine periosteal stripping may be unnecessary. Level of Evidence: Level III.

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