From the Guidelines
The distal tibia physis typically closes between 14-16 years of age in females and 16 years of age in males. This information is crucial for orthopedic management in children, particularly those with conditions like X-linked hypophosphataemia (XLH) [ 1 ]. The age of the child is an important factor in the decision-making process for surgical treatment, with guided growth techniques depending on the remaining growth potential of the child and ideally performed at least 2-3 years before skeletal maturity [ 1 ]. The timing of physeal closure is essential for planning interventions that rely on growth modulation, such as osteotomies or guided growth techniques, to correct deformities in the lower limb [ 1 ].
Key considerations for orthopedic management in children with XLH include:
- Emphasizing weight-bearing exercise and maintaining joint range and strength [ 1 ]
- Considering the age of the child and the remaining growth potential when deciding on surgical treatment [ 1 ]
- Delaying surgical treatment for residual deformity until skeletal maturity might be prudent, especially in young children or those with poor metabolic control [ 1 ]
- Guided growth techniques can be an effective option for correcting deformities, but require careful planning and monitoring to avoid overcorrection or rebound deformity [ 1 ]
In terms of assessing surgical outcomes, postoperative evaluation should include documentation of axis correction at 12 months, as well as functional assessment using tools like the Pediatric Outcomes Data Collection Instrument (PODCI) or the 6MWT [ 1 ]. By considering the timing of distal tibia physis closure and individualizing treatment approaches, clinicians can optimize outcomes for children with XLH and other orthopedic conditions.
From the Research
Distal Tibia Physis Closure Age
- The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 years 2.
- Complete growth plate fusion of the distal tibia occurs in 97% of individuals by the age of 17 in females and 19 in males 3.
- The process of growth plate fusion can be assessed by MRI and is influenced by factors such as sex, pubertal development, and BMI 3.
- MRI studies have shown that the distal tibial physis develops an anteromedial undulation before closure, and the cartilaginous epiphysis has a lower signal intensity than the physis on T2-weighted images 4.
- The exact timing of distal tibia physis closure may vary depending on individual factors, but generally occurs during adolescence 2, 3.