Distal Femoral Physeal Fractures

Young, Ernest Y.; Stans, Anthony A.

doi:10.1055/s-0038-1627465

Cited by 14 publications

(18 citation statements)

References 13 publications

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“…Particularly at the distal femoral region, even type II fractures can cause physeal growth arrest and angular deformity, so that reduction maneuvers must be applied gently and avoid further physeal damage. At this region, type III-IV fractures have higher incidence of physeal arrest and must be treated with open reduction and internal fixation because of closed reduction can cause physeal bar due to loss of reduction [39][40][41][42]. At the surgery for type IV fractures, two parallel Kirschner wires or screws must be chosen for fixation instead of Kirschner wires or screws passing physis in order to avoid causing physeal bar.…”

Section: Resultsmentioning

confidence: 99%

Should we really compress the fracture line in the treatment of Salter–Harris type 4 distal femoral fractures? A biomechanical study

İnal¹,

Gök

et al. 2018

J Braz. Soc. Mech. Sci. Eng.

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In this study, the indirect effect on physeal plate during interfragmentary compression of a Salter-Harris (SH) type 4 distal femoral fracture has been investigated. Three Dimensional (3D) model of a single configuration has been performed via SolidWorks. ANSYS Workbench software was used for numerical analyses. All boundary conditions have been defined in finite element analysis software. Since it is premature to state that compression created an additional stress load on the physeal plate in vivo, according to our results, it has been found that lateromedial compression in SH type 4 fracture of the distal femur caused an additional stress load on the physeal plate ex vivo. It is believed that screws need to be fixed without compression to avoid an additional iatrogenic physeal injury.

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Section: Resultsmentioning

confidence: 99%

Should we really compress the fracture line in the treatment of Salter–Harris type 4 distal femoral fractures? A biomechanical study

İnal¹,

Gök

et al. 2018

J Braz. Soc. Mech. Sci. Eng.

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“…Given the differences in tissue formation and limb growth trajectories between the hydrogels, careful selection of the α‐VEGF delivery system is important. Potential clinical applications of α‐VEGF delivery after physeal injury include its use as a prophylactic treatment for injuries at high risk for forming a bony bar, including distal radial and distal femur fractures 2,4 . In conclusion, the quick local delivery of α‐VEGF could have implications for the clinical management of physeal injuries and warrants further investigation.…”

Section: Discussionmentioning

confidence: 97%

“…The reduction of bony bar formation is promising, as any reduction can lead to positive growth outcomes by attenuating limb length discrepancies 4,5 . In the clinic, this would mean that fewer pediatric patients would undergo multiple corrective surgeries including osteotomies and limb lengthening procedures throughout their childhood 2 .…”

Section: Discussionmentioning

confidence: 99%

“…The physis is a cartilage tissue that drives long bone elongation through the process of endochondral ossification, in which the physeal cartilage template is replaced by incoming bone 1 . Trauma to long bones can result in the formation of a “bony bar,” which can span the physis, halt bone growth, and cause limb length discrepancies and/or angular deformities 2–5 . The current treatment to prevent these deformities includes surgical resection of the bony bar, followed by insertion of an inert interpositional material, such as silicone to prevent bony bar reformation 6,7 .…”

Section: Introductionmentioning

confidence: 99%

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Anti‐VEGF antibody delivered locally reduces bony bar formation following physeal injury in rats

Erickson

Newsom

Fletcher

et al. 2020

Journal Orthopaedic Research

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Physeal injuries can result in the formation of a “bony bar” which can lead to bone growth arrest and deformities in children. Vascular endothelial growth factor (VEGF) has been shown to play a role in bony bar formation, making it a potential target to inhibit bony repair tissue after physeal injury. The goal of this study was to investigate whether the local delivery of anti‐VEGF antibody (α‐VEGF; 7.5 μg) from alginate:chitosan hydrogels to the tibial physeal injury site in rats prevents bony bar formation. We tested the effects of quick or delayed delivery of α‐VEGF using both 90:10 and 50:50 ratio alginate:chitosan hydrogels, respectively. Male and female 6‐week‐old Sprague‐Dawley rats received a tibial physeal injury and the injured site injected with alginate‐chitosan hydrogels: (1) 90:10 (Quick Release); (2) 90:10 + α‐VEGF (Quick Release + α‐VEGF); (3) 50:50 (Slow Release); (4) 50:50 + α‐VEGF (Slow Release + α‐VEGF); or (5) Untreated. At 2, 4, and 24 weeks postinjury, animals were euthanized and tibiae assessed for bony bar and vessel formation, repair tissue type, and limb lengthening. Our results indicate that Quick Release + α‐VEGF reduced bony bar and vessel formation, while also increasing cartilage repair tissue. Further, the quick release of α‐VEGF neither affected limb lengthening nor caused deleterious side‐effects in the adjacent, uninjured physis. This α‐VEGF treatment, which inhibits bony bar formation without interfering with normal bone elongation, could have positive implications for children suffering from physeal injuries.

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“…Femoral shaft fractures, which are predominantly noted in young people with healthy bones (9), are caused mostly by road tra c accidents (being crushed or run over) or falling from a great height (9). Distal femoral fractures are rare injuries, accounting for approximately 2% of all femoral injuries (10), and often develop as a result of vehicular trauma or sports activities with varus or valgus impact at the knee (10).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Nutritional Index Is a Better Predictor of Perioperative Adverse Outcomes in Patients With Femoral Fractures: a Retrospective Study

He¹,

Fan²,

Zhu³

et al. 2021

Preprint

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Background: Surgery is usually the best treatment for patients with femoral fractures. However, the incidence of perioperative adverse outcomes in such cases is quite high. Nutrition has a major influence on fracture healing, and malnutrition is associated with higher complication rates, higher mortality rates, and longer hospitalisation periods. In this study, we aimed to identify independent risk factors and assess the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods: This retrospective observational study included 343 patients who underwent surgery for a single femur fracture at the Affiliated Hospital of Zunyi Medical University in 2018. Binary logistic regression analysis was applied to identify significant independent risk factors. The discriminatory ability of independent predictors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). Results: In total, 159 patients (46.4%) had perioperative adverse outcomes. PNI (OR: 0.819, 95% CI: 0.754–0.889, P < 0.001), age (OR: 1.042, 95% CI: 1.020–1.066, P < 0.001), time to admission (OR: 1.404, 95% CI: 1.117–1.765, P = 0.004), hypertension (OR: 1.912, 95% CI: 1.049–3.488, P = 0.034), combined injures (OR: 2.739, 95% CI: 1.338–5.607, P = 0.006), and operation types (OR: 3.696, 95% CI: 1.913–7.138, P < 0.001) were independent factors for perioperative adverse outcomes. Based on the AUC (PNI: 0.772, 95% CI: 0.723–0.821, P < 0.001; age: 0.678, 95% CI: 0.622–0.734, P < 0.001; time to admission: 0.585, 95% CI: 0.525–0.646, P = 0.006), the PNI had the optimal discrimination ability, indicating its superiority over other independent predictors (age vs. PNI, P = 0.002; time to admission vs. PNI, P < 0.001). Conclusions: This study showed that the PNI was a better and effective independent predictor of perioperative adverse outcomes in patients with femoral fractures. Our findings suggest that nutritional assessment at admission and appropriate intervention strategies are necessary for patients with femoral fractures.

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Distal Femoral Physeal Fractures

Cited by 14 publications

References 13 publications

Should we really compress the fracture line in the treatment of Salter–Harris type 4 distal femoral fractures? A biomechanical study

Should we really compress the fracture line in the treatment of Salter–Harris type 4 distal femoral fractures? A biomechanical study

Anti‐VEGF antibody delivered locally reduces bony bar formation following physeal injury in rats

Prognostic Nutritional Index Is a Better Predictor of Perioperative Adverse Outcomes in Patients With Femoral Fractures: a Retrospective Study

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