Il trattamento degli esiti dei distacchi epifisari degli arti inferiori

Background. The aim of the study is the evaluation of the outcomes of the physeal fractures of the lower limbs. Methods. The authors carried out a retrospective study of a series of cases regarding the treatment of patients suffering from the outcome of physeal fractures of the lower limbs, with a follow-up from 3 to 7 years depending on the place of the previous injury. 12 patients are included (4 distal tibia, 6 distal femur, 2 proximal tibia), in which the rare unfavourable outcomes are related to growth disorders. If the physeal injury affects the entire cartilage or its central portion, the limb will present length discrepancy due to shortening, whereas in case of partial damage the deformity will be an axial deviation. The treatment includes surgery of the growing cartilage and bone surgery. In the first case, medial hemiepiphysiodesis according to Blount is the treatment of choice for the correction during the growth of genu valgum. As to bone surgery, it should be performed towards the end of skeletal growth and includes osteotomies, and lengthenings, that can be performed with axial external fixators when no axial defects are associated, or with circular frames if deformities are present on multiple planes. Results. The authors report the results of the surgical treatment, which can not be easily summarized in a series of cases covering a period of over 30 years. Conclusions. The surgical treatment of the unfavourable outcomes of the physeal fractures is performed towards the end of the skeletal growth depending on the degree of deformity, and includes osteotomies in the axial defects, lenghtenings with axial external fixators in limb shortenings and surgery with Ilizarov technique in complex deformities.