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Background  The purpose of this study was to evaluate the factors that influence residual angulation after treating pediatric distal tibial diaphyseal fractures.    Methods  We retrospectively reviewed the records of 75 children under the age of ten who were treated at two referral centers for distal tibial diaphyseal fractures. The mean patient age was 6.8 ± 2.3 years, and the mean follow-up duration was 4.1 ± 1.3 years (range, 3 to 6 years). Early postoperative and late follow-up radiographs were used to measure angulation.    Results  Twenty-four patients had valgus angulations >5° at the final follow-up. There was no varus, or anteroposterior residual angulations >5°. There was more residual valgus angulation when the postoperative angulation was >5° ( p  = 0.006) and when intramedullary nail and external fixators were applied for treatment ( p  = 0.004). Multivariate logistic regression analysis showed that postoperative angulation (adjusted odds ratio (OR) 4.33, 95% confidence interval (CI) 1.07–17.53) and treatment methods (intramedullary nail: adjusted OR 7.33, 95% CI 1.31–41.07; external fixator: adjusted OR 11.35, 95% CI 1.91–67.40 compared with the cast group) were associated with residual deformity.    Conclusions  Valgus angulation after pediatric distal tibial fractures persisted in this study sample. Accurate reduction should be performed to prevent residual deformity.

Residual angulation of distal tibial diaphyseal fractures in children younger than ten years