Therefore, we compared the incidence of PPC after operative treatment with that after nonoperative treatment in displaced SH II distal tibial fractures with residual gap of >3 mm, and aimed to analyze the factors that may be associated with PPC incidence. To our knowledge, there is no clinical study that directly compared operative treatment with nonoperative treatment for displaced SH II distal tibial fractures with a residual gap of >3 mm to prove the superiority of surgical treatment as suggested by Barmada et al. Although some authors recently reported the results of surgical treatment only for displaced SH II distal tibial fractures, they included patients with residual gap of 4 mm after closed reduction (Russo et al. Most previous studies included patients with all types of physeal fractures and even transitional fractures (Barmada et al. However, some authors insist that surgical management of these fractures does not reduce the incidence of PPC, and might increase the need for subsequent surgeries (Russo et al. ( 2003) suggested that open reduction and removal of the entrapped periosteum in displaced SH II fractures with residual physeal gap of >3 mm may be beneficial for reducing the incidence of PPC, and it seems to be a current trend that a surgical approach is the treatment of choice in displaced SH II fractures of the distal tibia. Several recent studies reported that the incidence of PPC was 25–40% in SH II distal tibial fractures (Barmada et al. However, some studies indicate that PPC may be more common than previously realized in specifically SH II distal tibial fractures (Spiegel et al. SH II fractures are considered low-risk fractures because the incidence of premature physeal closure (PPC) was reported as 2–5% in a previous study (Dugan et al. Among these, Salter–Harris type II (SH II) fractures are the most common, accounting for 40% of all distal tibial fractures in children (Spiegel et al. Physeal injuries of the distal tibia account for one-tenth of all physeal fractures (Peterson et al.
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