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. 2020 Jun 1;14(3):213-220.
doi: 10.1302/1863-2548.14.190147.

Does Cozen's phenomenon warrant surgical intervention?

Yvonne-Mary Papamerkouriou  1 , Pantelis Tsoumpos  2 , George Tagaris  2 , George Christodoulou  2
Affiliations

Does Cozen's phenomenon warrant surgical intervention?

Yvonne-Mary Papamerkouriou et al. J Child Orthop. .

Abstract

Purpose: Proximal tibial metaphyseal fractures can be complicated by a late valgus deformity, referred to as Cozen's phenomenon. We studied children with such fractures to determine whether the child's age at the time of injury influenced the development of Cozen's as well as the occurrence of elongation. In addition, we explored whether the deformity resolved at long-term follow-up.

Methods: We conducted a retrospective study of 33 patients (six months to 14 years old). Mean follow-up was 8.8 years (3 to 25). We measured angulation of the fractured limb post-treatment, at maximum deformity and final follow-up, as well as elongation and compared them with the uninjured limb.

Results: Three of the fractures were treated surgically whereas the rest, nonoperatively. In all, 15 out of 33 fractures developed late valgus deformity between eight and 19 months (mean time 12.5 months). A total of 24 fractures developed elongation. We found no association of either of these with age. Angulation increased to a statistically significant level, from post-treatment to maximum deformity, and then decreased at final follow-up, leaving no statistically significant difference from the initial measurement. The difference in valgus between fractured and uninjured limb increased to a statistically significant level from post-treatment to maximum deformity and then decreased, leaving an excess from the initial measurement.

Conclusion: In almost half the patients, late valgus deformity developed within two years post-fracture and corrected to the initial post-treatment angles. Patients should be warned of this possibility and reassured of its natural resolution.

Level of evidence: IV.

Keywords: Cozen’s phenomenon; age; children; elongation; proximal tibial metaphyseal fractures; valgus deformity.

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Figures

Fig. 1.
Fig. 1.
Age follow-up graph including: age of the children when treated; age of the patients at final follow-up; and years of follow-up. Children’s ages have been rounded to the nearest integer.
Fig. 2.
Fig. 2.
Four-year-old patient, right uninjured limb at time of injury.
Fig. 3.
Fig. 3.
Four-year-old patient, left limb greenstick fracture.
Fig. 4.
Fig. 4.
Left limb after cast wedging.
Fig. 5.
Fig. 5.
Both limbs standing X-ray at 18 months post-injury where there is a 19° angulation of the left limb.
Fig. 6.
Fig. 6.
The 25-year follow-up X-rays of right and left limb. Left injured limb has a remaining angulation of 5° compared with the right uninjured side.
Fig. 7.
Fig. 7.
Box plots of valgus angle of injured limb post-treatment, at maximum deformity, at final follow-up
Fig. 8.
Fig. 8.
Box plots of difference in the valgus angle between injured and uninjured limb post-treatment, at maximum deformity, at final follow-up
See this image and copyright information in PMC

References

    1. Skak SV. Valgus deformity following proximal tibial metaphyseal fracture in children. Acta Orthop Scand 1982;53:141-147. - PubMed
    1. Rang M. Childrens’ fractures. Philadelphia; Lippincott JB, 1983.
    1. Cozen L. Fracture of the proximal portion of the tibia in children followed by valgus deformity. Surg Gynecol Obstet 1953;97:183-188. - PubMed
    1. Visser JD, Veldhuizen AG. Valgus deformity after fracture of the proximal tibial metaphysis in childhood. Acta Orthop Scand 1982;53:663-667. - PubMed
    1. Yap BW, Sim CH. Power comparison of Shapiro-Wilk, Kolmogorov-Smirnov, Lilliefors and Anderson-Darling tests. J. Stat. Model. Analytics 2011;1:21-33.