Evaluation of pediatric distal femoral physeal fractures and the factors impacting poor outcome requiring further corrective surgery

Abstract

Fractures of the distal femur carry a significant risk of physeal arrest and resulting growth complications which often require additional surgeries to correct the deformity. This study examines the risk of needing corrective procedures as a child approaches skeletal maturity. A retrospective analysis of patients treated at a single institution for distal femoral physeal fractures from 2000 to 2015 was performed. Association between sex, age, Salter–Harris (SH) class, and fracture displacement with the risk of physeal arrest were examined. Association between years of growth remaining to skeletal maturity and the risk of needing additional corrective surgery (defined by leg length difference >2 cm or angular deformity (>5°) was examined using a logistic regression model. One hundred one patients were available for review with an average age of 12.6 ± 3.2 years. Twenty-six patients (25.7%) developed a physeal arrest. Seventy-six percent of these required subsequent surgical intervention to address length and angular deformities Sex, age, and SH class were not significantly associated with physeal arrest (P > 0.05). Percent fracture displacement was significantly associated with physeal arrest (P = 0.02). Years of growth remaining to skeletal maturity were significantly associated with an increased risk of requiring corrective surgery for growth complications (odds ratio: 0.758; 95% confidence interval 0.587–0.979; P = 0.03), however, this association failed to persist when accounting for age. Years of growth remaining to skeletal maturity may predict the need for future interventions and should be accounted for when planning treatment of these challenging injuries.

A Rare Case of Salter-Harris Type I Growth Plate Injury in a Patient Undergoing Limb-Lengthening Procedure

“…When compared to other subtypes of SH fractures, type I fractures were associated with the lowest risk of growth disturbances in a meta-analysis of 564 fractures [ 2 ]. Bellamy et al concluded that the severity of fracture displacement and remaining years of growth until skeletal maturity was associated with an increased risk of requiring corrective surgery for growth disturbance [ 10 ]. In addition to fracture displacement, Arkader et al stated that the severity of fracture according to SH classification was significantly correlated with the incidence of growth disturbance [ 1 ].…”

Pediatric neglected distal femoral fracture with growth arrest

“…Although SH Type II fracture is the most commonly reported physeal fracture, SH type IV fracture seems to have the worst impact on bone growth demonstrated by having the highest incidence of growth rate disturbance compared to other SH fracture types. Overall, more than one-fifth of the growth plate fracture occurring on distal femurs exhibited leg length discrepancy of more than 1.5 cm as a sequela, reported from pooled data [1] , [7] , [8] .…”

“…Out of the five possible types in the classification, distal femoral physeal fractures are commonly seen with SH type II fractures, not excluding possibilities of other fracture types occurring. Complications that may arise are hindered growth, irreversible decrease in range of motion, and angular deformity [1] , [7] , [8] .…”

Epidemiology and risk factors for premature physeal closure in distal femur fractures

“…In multivariable analysis, dislocation exceeding 10 mm was a risk factor for PPC (OR 6.3, CI 1. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

“…Mechanism of injury often involves highenergy trauma, with the most common injury mechanisms being motor vehicle accidents (MVA), sports-related accidents, and falls [4][5][6]. The fractures exhibit exceptionally high complication rates, most commonly premature physeal closure (PPC), which has been reported to occur in up to 21-35% of patients [4][5][6][7][8].…”