Introduction: This study examines the proximal tibial metaphyseal fractures in children and specifically the valgus deformity and leg overgrowth of the tibia.

Methods: We examined 27 children with proximal tibial metaphyseal fractures. Among them, 11 presented with greenstick fractures, 6 with complete, 5 with hairline, 3 with torus and 2 with stress fractures. The mean age was 7 years old (1–14). The average follow up period was 9.5 years. Fifteen children were below the age of 7 while 12 were between 8–14 years old. Twenty five patients were treated conservatively and 2 surgically.

Results: Valgus deformity occurred during the follow up period in 73% of the children aged below 7 y.o. and 17% of the older children. The higher values of valgus deformity ranged between 8–18 degrees and were observed at 10–18 months post-traumatically, especially in younger ages and after inadequate reductions. At the time of the final follow up examination, satisfactory spontaneous correction of the deformity, inversely proportional to age was observed in all cases. The degree of final valgus deformity ranged between 1–9 degrees. Overgrowth of the affected extremity was observed in 74% of the cases and ranged between 0, 4 and 1, 5 cm. Tibial overgrowth is not dependent to skeletal age. None of torus and stress fractures developed valgus deformity or longitudinal overgrowth. Compartment syndrome occurred in one case.

Conclusion: A high tendency to valgus deformity, especially in younger ages, was observed in proximal tibial metaphyseal fractures, even among undisplaced or surgically treated ones. Approximately two years post-traumatically, the beginning of a progressive spontaneous satisfactory correction of the deformity – inversely proportional to age – was noticed. It is worth mentioning that valgus deformity up to 10 degrees and tibial overgrowth up to 1, 5 cm cause no functional or cosmetic problems. The above observations prevent us from unnecessary surgical correction. Conservative treatment is preferred for the proximal tibial metaphyseal fractures. Operative treatment is indicated after inadequate reduction, especially in older children and after open fractures.

Purpose: The purpose of this work was to study Monteggia fracture-dislocation in children and report results of treatment.

Material and methods: Thirty-two children were treated for Monteggia fracture-dislocation during a 12-year period from 1989 to 2001. The Bado classification was type I (n=22, 69%), type II (n=2, 7%), and type III (n=8, 24%). There were no type IV. Mean follow-up was seven years (1–12 yr). Mean age at treatment was six years (3–12 yr). There were 26 boys (81%) and 6 girls (19%). The right side was involved in 62% of patients. Orthopaedic treatment was use for 31 patients. Open surgery was performed for one child.

Results: Early complications were rupture and migration of the osteosynthesis material and transient palsy of the posterior interosseous in one patient. Late complications were malunion with 20° ulnar varus in four patients. Residual posterior tilt of the ulna (up to 10°) was observed in two children and anterior tilt in one other. Elbow function was perfect in all children. For children had minor cubital varus.

Discussion: Thirty-one children were given orthopaedic treatment with closed reduction of the ulnar fracture and radial head dislocation and immobilisation with a brachio-antebrachio-palmar brace. There were no cases of recurrent radial head dislocation, even with ulnar mal-union with 20° deviation. There were no cases of secondary displacement or recurrend dislocation despite rather unstable and oblique fractures. One patient required open reduction of the radial head followed by transcondylo-radial pinning. Closed reduction failed because of a ruptured annular ligament. In this patient, the pin was removed at three weeks because of pin fracture and migration to the wrist.

Conclusion: Early orthopaedic reduction is indicated as first-intention treatment for these fractures in children. The prognosis is excellent for patients treated early. When closed reduction is impossible or in the event of recurrent dislocation of the radial head, open surgery may be needed.