Background: The treatment for displaced Salter-Harris Ⅱ distal tibia fractures remains controversial. The purpose of this study was to evaluate the rate of premature physeal closure (PPC) and to identify the risk factors treated by open reduction and internal fixation.Methods: We reviewed the charts and radiographs of patients with Salter-Harris Ⅱ fractures of the distal tibia with displacement >3mm between 2012 and 2019. Open reduction and internal fixation was performed for all patients.

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... nts were followed up for a minimum of 4 months. Contralateral ankle radiograph or CT scans were obtained if there was any evidence of premature physeal closure. Any angular deformity or shortening of the involved leg was documented.Results: A total of 85 patients with a mean age of 12.3years were included in the study. The mean initial displacement was 8.5 mm. All patients but one were treated within seven days after injury and the mean interval was 3.7 days. SER injuries occurred in 65 patients (76.5%), PER in 17 (20.0%), and SPF in three (3.5%). The rate of PPC was 29.4% and two patients with PPC had varus deformities. The rate of PPC was significantly greater in patients with associated fibular fracture as compared with those with intact fibular (P=0.005). Patient age, gender, injured side, mechanism of injury (only SER vs PER), amount of initial displacement, interval from injury to surgery, or energy of injury did not affect the rate of PPC significantly. Conclusions: PPC is a common complication for displaced S-H Ⅱ distal tibia physeal fractures. We suggest that open reduction internal fixation is an effective choice to reduce the risk of PPC. The presence of concomitant fibula fracture was associated with PPC.