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synonyms: Proximal Metaphyseal fracture, Cozen's Fracture
Pediatric Proximal Tibial Fracture ICD-10
A- initial encounter for closed fracture
B- initial encounter for open fracture
C- initial encounter for open fracture type IIIA, IIIB, or IIIC
D- subsequent encounter for fracture with routine healing
E- subsequent encounter for open fracture type I or II with routine healing
F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
G- subsequent encounter for fracture with delayed healing
H- subsequent encounter for open fracture type I or II with delayed healing
J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
K- subsequent encounter for fracture with nonunion
M- subsequent encounter for open fracture type I or II with nonunion
N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
P- subsequent encounter for fracture with malunion
Q- subsequent encounter for open fracture type I or II with malunion
R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S- sequela
Pediatric Proximal Tibial Fracture ICD-9
- 823.4(Torus fracture), 823.00(upper end, closed), 823.20(upper end open), 823.02(upper end with fibula fx, closed), 823.22(upper end with fibular fx, open), 823.20(shaft closed), 823.22(shaft closed with fibula fx), 823.30(shaft, open)
- usually children age 6 years or younger
- associated with tibial overgrowth and a progressive valgus deformity can develop.
Pediatric Proximal Tibial Fracture Etiology / Epidemiology / Natural History
- Common in children 2-6 years old.
- Generally fall from height or direct blow.
Pediatric Proximal Tibial Fracture Anatomy
Pediatric Proximal Tibial Fracture Clinical Evaluation
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- Leg pain, inability to bear weight, contusions, deformity
- Evaluate extent of soft tissues, open fracture injury
- Document neurovascular exam before and after any treatment
- Evaluate for Compartment Syndrome.
Pediatric Proximal Tibial Fracture Xray / Diagnositc Tests
- A/P and Lateral of tibia, must include ankle and knee
- CT if intraarticular extention is a concern.
Pediatric Proximal Tibial Fracture Classification / Treatment
- Transverse impaction fracture, greenstick fracture in patient <6years old
-Treatment: To minimize the development of valgus deformity, any acute valgus fracture deformity must be reduced or overreduced with the extremity immobilized in a long-leg cast in extension. Discuss unpredictable tendency for valgus deformity with parents.
- High Energy fracture in patient >6years old
-Treatment: dependent on soft tissue injury and fracture displacement. Options: cast, Ex Fix, ORIF.
- Valgus Deformity: always discuss with parents before treatment. Occurs in 50% of proximal metaphyseal fractures. Maximal deformity occurs at 18 months postinjury followed by gradually remodelling over several years. (Robert M, JPO 1987;7:444).
- Valgus deformity noted after fracture healing should be observed. Initial progression of deformity is typically followed by subsequent remodeling for mild to moderate deformities.
- Correction by osteotomy or staple should be deferred as long as possible so as to minimize the potential for recurrence. Correction of a recurrence, if necessary, can be obtained with staple hemiepiphysiodesis. (McCarthy JJ, JPO 1998;18:518).
Pediatric Proximal Tibial Fracture Associated Injuries / Differential Diagnosis
- Pediatric tibial shaft fracture
- Vascular injury: popliteal artery is tethered by the major branches near the posterior aspect of the proximal tibial epiphysis.
Pediatric Proximal Tibial Fracture Complications
Pediatric Proximal Tibial Fracture Follow-up Care
- Typically heals in 3 weeks.
- 6-12 month follow-ups to ensure valgus deformity does not develop.
Pediatric Proximal Tibial Fracture Review References
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