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Review Question - QID 3270

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QID 3270 (Type "3270" in App Search)
A 5-year-old girl falls off of a trampoline and sustains a tibia fracture. The tibia fracture is reduced and placed into a long leg cast in the emergency room. A post-reduction radiograph is provided in Figure A. The parents should be counseled that a temporary tibial deformity may occur. Which of the following best describes the potential deformity?
  • A

Recurvatum

3%

140/4084

Varus

18%

736/4084

Malrotation

1%

48/4084

Valgus

71%

2889/4084

Procurvatum

6%

248/4084

  • A

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Pediatric proximal tibia metaphyseal fractures, or Cozen fractures, heal reliably but often progress to a valgus deformity. The valgus deformity seen with Cozen fractures is secondary to an increase in metaphyseal growth medially. Zionts and MacEwen peformed a retrospective review of 7 patients with Cozen fractures and found that the valgus angulation progressed most rapidly during the first year after the injury, and then continued at a slower rate for as long as seventeen months.

Tuten et al. then re-reviewed this same cohort at 15 year followup and found that the valgus angulation completely resolved in 100% of cases. However, the affected tibia was longer than the contralateral tibia in 100% of cases with an average limb-length discrepancy of 9 mm.

Ogden et al., in a retrospective review, found radiographic evidence that the medial metaphysis was longer in every instance compared to the distance laterally. Illustration A is another example of a proximal tibia fracture that developed valgus overgrowth as evidenced in Illustration B. This particular case underwent medial stapling for guided growth.

Zionts et al. peformed a retrospective review of 7 patients with Cozen fractures and found that the valgus angulation progressed most rapidly during the first year after the injury, and then continued at a slower rate for as long as seventeen months.

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