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Clinical Practice Guidelines

Distal tibia and-or fibula physeal fractures - Outpatient clinics

  • Fracture Guideline Index

    See also:  Distal tibia and /or fibula physeal fractures - Outpatient clinics

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?

    1. How often should these fractures be followed up in fracture clinics?

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    Isolated undisplaced distal fibula physeal - Salter-Harris type I and II

    7-10 days

    4 weeks for clinical and x-ray review. Remove cast and commence weight bearing as tolerated

    Undisplaced distal tibia physeal

    7 days post-ED presentation/injury with x-ray
    • 2 weeks
    • 6 weeks for clinical and x-ray review. Remove cast and commence weight bearing as tolerated
    • 12 weeks. This can also be provided by a GP

    Expect approximately 12 weeks before returning to sports. Patients will need review at 6 -9 months to assess for physeal arrest

    Displaced distal tibia physeal

    5 days if treated with closed reduction, 2 weeks if treated surgically
    • 6 weeks for clinical and x-ray review. Remove cast and commence weight bearing as tolerated
    • 12 weeks. This can also be provided by a GP

    Expect approximately 12 weeks before returning to sports. Patients will need review at 6 -9 months to assess for physeal arrest

    Tillaux and triplanefracture <2 mm displacement

    7 days
    • 2 weeks
    • 6 weeks for clinical and x-ray review. Remove cast and commence weight bearing as tolerated
    • 12 weeks. This can also be provided by a GP

    Expect approximately 12 weeks before returning to sports. Patients will need review at 6 -9 months to assess for physeal arrest

    Tillaux and triplane fracture >2 mm displacement

    2 weeks post-operatively
    • 6 weeks for clinical and x-ray review. Remove cast and commence weight bearing as tolerated
    • 12 weeks. This can also be provided by a GP

    Expect approximately 12 weeks before returning to sports. Patients will need review at 6 -9 months to assess for physeal arrest


    2. What should I review at each appointment?

    • Position/alignment of the fracture
    • Degree of new bone formation and stability of the fracture site
    • Neurovascular status of the limb
    • Can the patient be changed into a below-knee walking cast and begin to weight bear?

    3. What are the potential complications associated with this injury?

    • Growth arrest
    • Arthritis
    • Infection
    • Compartment syndrome/neurovascular injury

    4. When should I refer for an orthopaedic consultant opinion?

    Indications for a consultant orthopaedic surgeon opinion are:

    • loss of position of the fracture
    • any concern of a complication during treatment

    5. What are the indications for discharge?

    Patients should be followed up until their fracture has healed and they have returned to normal activities.  This is usually by 10-12 weeks post-injury.  Patients should then be reviewed with x-ray 6 -9 months after injury to assess for growth arrest in a consultant clinic.  At this point, patients can be discharged if there are no other concerns.  If treated surgically, patients should be reviewed in the consultant clinic at 9 -12 months to consider need for hardware removal. 

    References (Outpatient setting)

    Cummings RJ, Shea KG.  Distal tibial and fibular fractures. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.967-1016.

    Schnetzler KA, Hoernschemeyer D.  The Pediatric Triplane Ankle Fracture.  J Am Acad Ortho Surg 2007; 15(12): 738 -47.