![]() Since that time, many other investigators 6, 23, 52, 53, 75, 79, 94, 116, 149, 153, 158 have reported development of tibia valga, even in fractures without any significant malalignment at the time of initial treatment. In the other two patients the tibia valga developed gradually during subsequent growth of the patient. ![]() In two cases, the valgus was present at the time of cast removal, suggesting loss of reduction as a potential cause of the deformity. He described four patients with valgus deformities after fractures in this area. In 1953, Cozen 24 was the first to report valgus deformity following a proximal tibial metaphyseal fracture. The medial aspect of the fracture often is widened, producing a valgus deformity.Ī possible sequela of a proximal tibial metaphyseal fracture is development of a progressive valgus deformity ( Fig. Crepitance is seldom identified on physical examination, especially if the fracture is incomplete. Motion of the knee causes moderate pain, and in most cases the child will not walk. 4, 6, 23, 24, 53, 75, 79, 84, 116, 134, 142, 148, 153, 158, 163, 164Ĭhildren with proximal tibia metaphyseal fractures present with pain, swelling, and tenderness in the region of the fracture. The fibula generally escapes injury, although plastic deformation may occur. Compression (torus) and complete fractures can occur in this area, but are less common. The cortex of the medial tibial metaphysis fails in tension, often resulting in an incomplete greenstick fracture. The most common mechanism of injury is a low energy force applied to the lateral aspect of the extended knee generating a valgus moment. ![]() The peak incidence for proximal tibia metaphyseal fractures is between the ages of 3 and 6 years. 51įIGURE 31-2 Fibroosseous compartments of the leg.į RACTURES OF THE P ROXIMAL T IBIAL M ETAPHYSIS The posterior tibial artery, peroneal artery, and posterior tibial nerve run in this compartment. The deep posterior compartment contains the flexor digitorum longus, the flexor hallucis longus, and the tibialis posterior muscles. The superficial posterior compartment contains the soleus and gastrocnemius muscles. The superficial peroneal nerve runs through this compartment. The lateral compartment contains the peroneus longus and brevis muscles. The anterior compartment contains the extensor digitorum longus, the extensor hallucis longus, and the tibialis anterior muscles the anterior tibial artery and deep peroneal nerve run in this compartment. The lower leg has four fascial compartments ( Fig. The superficial branch is responsible for sensation across the dorsal and lateral aspects of the foot. The deep peroneal nerve provides sensation to the first web space. Each branch innervates the muscles within its compartment. ![]() It divides into the deep and superficial branches, and then passes into the anterior and the lateral compartments of the lower leg, respectively. The common peroneal nerve passes laterally around the proximal neck of the fibula. This nerve provides innervation to the muscles of the deep posterior compartment and sensation to the plantar aspect of the foot. The posterior tibial nerve runs adjacent and posterior to the popliteal artery in the popliteal fossa, and then enters the deep posterior compartment of the leg. The fracture resembles the break that results when a supple green branch of a tree is bent and breaks incompletely.FIGURE 31-1 Vascular anatomy of the proximal tibia. incomplete fracture, with cortical breach of only one side of the bone.This fracture is very different, and much less common, than the torus fracture that results in buckling of the cortex on the concave side of the bend and an intact convex surface. an indirect trauma following a fall on an outstretched arm), or after a force applied perpendicular to the bone (e.g. This can occur following an angulated longitudinal force applied down the bone (e.g. However, the bending force applied does not break the bone completely and the concave surface of the bent bone remains intact. The fact that the integrity of the cortex has been overcome results in fracture of the convex surface. Greenstick fractures occur when the force applied to a bone results in bending of the bone such that the structural integrity of the convex surface is overcome.
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