Surgical versus nonsurgical treatment of distal femur physeal fractures: A systematic review and meta-analysis

Abstract

Distal femur physeal fractures can lead to growth disturbance such as premature physeal closure (PPC), leg length discrepancy (LLD), and angular deformity (AD). This study aims to systematically review the literature to assess whether surgical management is associated with a different rate of growth disturbances compared to nonsurgical treatment. We searched several databases from 1966 to 2018 for studies that evaluated surgical versus nonsurgical treatment of distal femur physeal fractures. Descriptive and quantitative data were extracted, and a meta-analysis was performed using a random-effects model to pool odds ratio (OR) for the comparison of PPC, LLD, and AD rate between children undergoing surgical versus nonsurgical treatment. Of the 470 articles identified, 11 case series were eligible, with a total of 527 distal femur physeal fractures. The pooled OR of PPC between surgical and nonsurgical treatments showed no statistically significant difference (OR = 0.30, 95% confidence interval [CI]: 0.30–3.03; I2 = 73.4%, P = 0.01). No significant difference in the rates of LLD (OR = 1.03, 95% CI: 0.36–2.94; I2 = 0%, P= 0.87) and AD (OR = 0.40, 95% CI: 0.10–1.57; I2 = 0%, P = 0.79) was detected between surgical and nonsurgical treatments. Despite the current evidence to date does not support an association between the method of treatment of distal femur physeal fractures and the risks of PPC, LLD, and AD, a significant clinical relevance cannot be carried out. Surgeons can use both treatment methods as dictated case by case.