Using biodegradable screws for metaepiphyseal fractures of the distal tibia

Introduction. The epiphyseal plate of the distal tibia is involved in the growth formation of 45% of the entire lower limb. Ossification of this area takes place between 12 and 14 years of age. Damage to the epiphyseal plate can lead to premature closure of the growth zone, deformation of the bone. and a significant limb length discrepency. Thus, the choice of surgical tactics should be carefully considered in case of fractures in the epiphyseal plate of the distal tibia in children because of growth zones in these bones. Objective. To assess the clinical effectiveness of biodegradable screws in type II metaepiphyseal fractures by the Salter–Harris classification after long-term catamnestic observation.

Materials and methods. There is presented a series of case reports of 14–15 years children with the damage to the growth zone (with closed metaepiphyseolysis of the distal tibia with type II displacement).

Results. The main advantages of biodegradable screws are sufficient strength and elasticity which are very important for maintaining stability of osteosynthesis in bone fragments. In addition, they have no any adverse effect at bone tissues in the meta-epiphyseal region, on intersection of the growth zone with the installed above metaphysical plate, thus reducing risks of displacement, non-fusion and premature closure of the growth zone in a young patient. The installed polylactate-glycolide (PLGA) implants do not require removal and repeated surgical intervention with general anesthetic support. Clinical cases analyzed in this trial have shown that in three years after the surgery screw bioresorption was not accompanied with any long-term consequences.

Conclusion. Based on the presented clinical observations and long-term results, bioresorbable screws based on PLGA have promising prospects for use in the surgical treatment of type II fractures of the distal metaepiphysis of the tibia according to the Salter–Harris classification. This is due to their ability to provide reliable stable osteosynthesis, a sufficient period of biodegradation, and the absence of adverse effects on surrounding soft and bone tissues. Additionally, there is no need for repeated surgery under anesthesia to remove the implant.

Contributions:
Serova N.Yu., Yatsyk S.P., Akhadov T.A., Chelpachenko O.B., Lushnikov A.M., Dmitrenko D.M., Kochetova N.A., Bykov V.M. — collection and processing of material;
Serova N.Yu., Chelpachenko O.B., Kochetova N.A., Bykov V.M. — writing the text;
Serova N.Yu., Chelpachenko O.B., Nikishov S.O. — editing the text.
Аll co-authors — аpproval of the final version of the article, responsibility for the integrity of all parts of the article. 

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 05, 2025
Accepted: October 02, 2025
Published: October 30, 2025

1. Rammelt S., Godoy-Santos A.L., Schneiders W., Fitze G., Zwipp H. Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment. Rev. Bras. Ortop. 2016; 51(6): 630–9. https://doi.org/10.1016/j.rboe.2016.09.001

2. Sananta P., Lesmana A., Alwy Sugiarto M. Growth plate injury in children: Review of literature on PubMed. J. Public Health Res. 2022; 11(3): 22799036221104155. https://doi.org/10.1177/22799036221104155

3. Ankin L.N., Ankin N.L. Injuries of the ankle joint. In: Traumatology. European Standards [Travmatologiya. Yevropeyskiye standarty]. Moscow: MEDpress-inform; 2005. (in Russian)

4. Salter R.B., Harris W.R. Injuries involving the epiphyseal plate. J. Bone Joint Surg. 1963; 45(3): 587–22. https://doi.org/10.2106/00004623-196345030-00019

5. Yamshchikov O.N., Emelyanov S.A., Chumakov R.V., Pavlova K.A. Successful open reduction of comminuted intra articular tibial fracture with subsequent osteosynthesis with titanium plate and screws. Vestnik SurGU. Meditsina. 2024; 17(1): 62–6. https://doi.org/10.35266/2949-3447-2024-1-9 https://elibrary.ru/bamgym (in Russian)

6. Rüedi T.P., Buckley R.E., Morgan C.G. Principles of Fracture Treatment. Moscow; 2007.

7. Budny A.M., Young B.A. Analysis of radiographic classifications for rotational ankle fractures. Clin. Podiatr. Med. Surg. 2008; 25(2): 139–52. https://doi.org/10.1016/j.cpm.2007.11.003

8. Yuan Q., Zhen Y., Guo Z., Zhang F., Fang J., Zhu Z., et al. Open reduction and internal fixation for displaced Salter-Harris type II fractures of the distal tibia: a retrospective study of sixty-five cases in children. J. Orthop. Surg. Res. 2021; 16(1): 224. https://doi.org/10.1186/s13018-021-02359-9

9. Sysenko Y.M., Nasyrov M.Z. The injuries of the epiphyseal growth cartilage of the distal leg and their treatment by transosseous osteosynthesis technique. Geniy ortopedii. 2004; (1): 107–13. https://elibrary.ru/pfteav (in Russian)

10. Palauro F.R., Stirma G.A., Secundino A.R., Riffel G.B., Baracho F., Kirschner L.D. Wire migration after the treatment of acromioclavicular luxation for the contralateral shoulder – case report. Rev. Bras. Ortop. (Sao Paulo). 2019; 54(2): 202–5. https://doi.org/10.1016/j.rbo.2017.09.017