الفهرس 
I. IntroductionOnly 14 pages are availabe for public view
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Abstract
This study included 38 cases with traumatic injuries of the distal tibial epiphysis, 28 cases (74.4%) were males and 10 (25.6%) females.
The age of the patients ranged from 4_17 years with a mean of 10 years and 9 months. The right side was affected in 22 cases (57.9%) and the left in 16 cases (42.1%).
The time lag between onset of trauma and treatment ranged from 24 hours up to 48 hours with a mean of 30 hours. Six cases (15.8%) were presented with open injuries.
6 (15.8%) cases were Salter Harris type I, 17 (44.7%) cases SH_ II, 11cases (28.9%) SH_III, 4 cases (10.5%) SH_ IV.
Immobilization period ranged from 6-8 week with a mean of 7.5 weeks.
FourFourteen cases were managed by closed methods, 7 cases (50%) were casted with no manipulation, 6 cases (42.85%) were subjected to one trial and 1 case (7.5%) was subjected to more than one manipulation.
24 cases were managed surgically, The implants used were: malleolar screw in 4 cases (7.9%) and KW in 20 cases (52.5%).
15 cases (39.5%) were treated by closed reduction and percutaneous pinning using k-wire.
2 cases (5.3%) were treated by closed reduction and percutaneous cannulated screw.
5 cases (13.2%) were treated by open reduction and internal fixation by k-wire.
2 cases (5.3%) were treated by open reduction and internal fixation by malleolar screw.
The follow-up periodwas 6 months.
At the end of the follow-up period, all patients were subjected to functional, clinical and radiological assessment to evaluate the end results. excellent results were encountered in 20 cases(52.6%),good results in 4 cases(10.5%) ,fair results in 13cases(34.2%)and poor results in 1 case(2.7%).
Excellent and good results were considered as satisfactory results. While fair and poor results were considered unsatisfactory results.
The results were found to be affected by:
Open injuries which had (83.3% unsatisfactory results)
Type according to Salter_Harris classification; where SH_I had the best prognosis (83.34% satisfactory results), SH_II had a guarded prognosis (70.6%satisfactory results), SH_III had a poor prognosis (64 %satisfactory results), while type IV had the worst prognosis (100 unsatisfactory result)
Residual displacement; where up to 1mm displacement in intra_articular fractures had (71.4%) unsatisfactory results and 2mm displacement had (100%) unsatisfactory results.
Number of manipulations:
Cases which were casted without manipulation gave better results (100% satisfactory) than those which subjected to one trial (50%satisfactory).while those which subjected to more than one trial had less satisfactory results (100% unsatisfactory). This proved that excessive manipulation add more injury to the epiphyseal growth plate.
There was no significant statistical relation between the results and sex, age and side affected.
The complications of that type of injury were studied; chronic pain was detected in 12 cases (31.6%), Limping was detected in 11(29%) cases, limitation of ankle movement was detected in 4 (10.5%) cases.
Angular deformities and limb length discrepancy were no detected due to the short period of follow _up.