LISBON, Portugal — Late valgus deformity after a proximal tibial metaphysis fracture in children, which was classified as Cozen’s phenomenon, developed in about half of the 33 patients included in a retrospective study conducted by investigators in Patras, Greece.
Yvonne-Mary Papamerkouriou, MD, MSc , who presented the results at the EFORT Annual Congress, and her colleagues studied the mean angulation in degrees of the fractured limb in patients and found it was 3° after reduction, 5.8° at maximum deformity and 3.1° at final follow-up in the study cohort. They compared this valgus angulation at each time point to the mean angulation in the proximal tibial metaphysis of patients’ uninjured limb, which they found was 2.5°, 2.2° and 1.2°, respectively.
According to the results, mean fracture elongation was 0.6 cm, however Papamerkouriou said this fracture feature did not correspond to the age of the patients, which she said the investigators thought might be the case.
“We have concluded in almost half of our patients, this late valgus deformity of the fracture limb was seen within 2 years of fracture compared to the post-reduction angles until the final follow-up. However, when compared to uninjured limb, there was an excess of valgus of the fractured limb at final follow-up. We suggest children with proximal tibia distal fractures be followed for at least 2 years post-fracture and further follow-up should be carried out for those who developed valgus deformity. There should be no hurry to advocate for surgical treatment,” she said.
In all, 15 patients developed valgus angle deformity.
Among the patients studied, 30 were treated conservatively and three patients were treated surgically.
Papamerkouriou said some of the fractures in this series were nondisplaced.
The indication for surgery, she said, “was a fracture that could not be handled anyway that was acceptable as far as reduction is concerned; but, in the three cases where we performed surgery, in fact two of the three [cases], we also had to perform fasciotomies because they were also in danger of compartment syndrome. So, they were treated openly with K-wires.” – by Susan M. Rapp
Papamerkouriou YM. Abstract 1937. Presented at: EFORT Annual Congress; June 5-7, 2019; Lisbon, Portugal.
Disclosures: Healio.com/Orthopedics was unable to confirm Papamerkouriou’s relevant financial disclosures.