Spiral fracture tibia

[physio.smith]

My 7 year old daughter spiral fractured her tibia at the end of July and spent just under 6/52 in an above knee cast. Was weightbearing fully for last 3. Has now been out of POP for nearly 3/52 and is continuing to walk with flexed knee and complain of pain at the knee and ankle....not over fracture sites.
My concern is hams length appears fine, quads and calf a little tight but walking as if off loading medial joint. Ext rot tibia with flexed knee, step too and not flexing at ankle, which she can do with bilat squat.
Knee ligs appear fine but med compartment appears to be catching and fully flexing knee she complains of pain in the knee. My concern is possible internal derrangement and growth plate... Picture of fracture shows possible growth plate injury (I think) dissmissed by reg at time as fine, which it may well be.
It's hard to be objective when it's your own child and am seeing paeds Physio next week.

Question is ...if meniscal / growth plate what can we / I do? I know watch and wait is probably the initial approach, however she is very sporty and is starting to compensate already with hip and back and getting increasingly frustrated she can't walk better / quicker.

Any advice from experienced MSK paeds Physios would be greatly appreciated.

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[physiobob]

Hi Physio.smith

Totally understand when it is your child but I would think at only 3/52 post POP removal that this is pretty normal for a child. I have seen teens with this type of casting for all manner of problems (recurrent dislocations etc) and all with something above the knee have been very slow to get the normal movement pattern back. So for my two cents worth I should think this is normal. Hopefully your peads physio will agree.

Did the fracture go into the joint line? or through the growth plate?

Here's some additional growth plate info I found on the web. Firstly uncommon and secondly only a small percentage of those that are have issues.

• Approximately 15% to 30% of all childhood fractures are growth plate fractures.
• Although growth plate injuries are common, serious problems are rare.
• Growth deformity occurs in 1% to 10% of all growth plate injuries.

[physio.smith]

Thank for reply.
I think it is harder to be objective when you see someone every day and you are emotionally attached!

I don't think my confidence in her treatment has been helped by changes in plan and certain experiences along the way. I thought there may be a growth plate injury on initial fracture but was dissmissed by reg as nothing....which it could be but looked like it to me.
She is weight-bearing more, so hopefully just needs time.