Physeal Fractures Research Articles

All-epiphyseal versus trans-epiphyseal screw fixation for tillaux fractures: Does it matter?

BACKGROUNDTillaux fractures occur primarily in adolescents due to the pattern of physeal closure and are classified as Salter-Harris type III physeal fractures. Operative management with screw fixation is recommended for more than 2 mm of displacement or more than 1 mm of translation. However, the efficacy and complications of trans-physeal vs all-physeal screw fixation have not been investigated extensively.AIMTo compare the clinical and functional outcomes of trans-physeal (oblique) and all-epiphyseal (parallel) screw fixation in management of Tillaux fractures among pediatric patients. METHODSThis was an ethics board approved retrospective review of pediatric patients who presented to our tertiary children’s care facility with Tillaux fractures. We included patients who had surgical fixation of a Tillaux fracture over a 10 year period. Data analysis included demographics, mode of injury, management protocols, and functional outcomes. The patients were divided into group 1 (oblique fixation) and group 2 (parallel fixation). Baseline patient characteristics and functional outcomes were compared between groups. Statistical tests to evaluate differences included Fisher’s Exact or Chi-squared and independent samples t or Mann Whitney tests for categorical and continuous variables, respectively.RESULTSA total of 42 patients (28 females and 14 males) were included. There were no significant differences in body mass index, sex, age, or time to surgery between the groups [IK2]. Sports injuries accounted for 61.9% of the cases, particularly non-contact (57.1%) and skating (28.6%) injuries. Computed Tomography (CT) scan was ordered for 28 patients (66.7%), leading to diagnosis confirmation in 17 patients and change in management plan in 11 patients. [GRC3] Groups 1 and 2 consisted of 17 and 25 patients, respectively. For mid to long-term functional outcomes, there were 14 and 10 patients in groups 1 and 2, respectively. Statistical analysis revealed no significant differences in the functional outcomes, pain scores, or satisfaction between groups. No infections, non-unions, physeal arrest, or post-operative ankle deformities were reported. Two (4.8%) patients had difficulty returning to sports post-surgery due to pain. One was a dancer, and the other patient had pain while running, which led to hardware removal. Both patients had parallel fixation. Hardware removal for groups 1 and 2 were 4 (23.5%) and 5 (20.0%) patients, respectively. The reasons for removal was pain in 2 patients, and parental preference in the remaining. CONCLUSIONThis is the largest reported series of pediatric patients with Tillaux fractures comparing functional outcomes of different methods of screw fixation orientation to the physis, which showed no difference regarding functional outcomes.

Outcomes of pediatric distal tibial physeal fractures

BackgroundFractures of the distal tibia involving the physis are relatively common in children. The data reported on long-term complication rates vary between studies. HypothesisPediatric distal tibial fractures cause medium- and long-term growth disturbances. Materials and methodsThis was a retrospective single-center study. We included physeal distal tibial fractures that were treated in the operating room with a minimum 12-month follow-up. The analysis included age, gender, weight status, circumstances and energy of the injury, fracture type, subsequent treatment, complications, duration of follow-up, radiologic findings and functional outcomes using the AOFAS. ResultsA total of 46 patients were included with a mean age of 12.8 years (2.4–15.9 years) and a mean follow-up of 35.8 months (12–119). At the longest follow-up, 7 patients (15.2%) had growth disturbances. The mean AOFAS score was 95/100 and a decreased ankle range of motion was observed in 18 patients, but it was always less than 10°. High-energy injuries (20 patients) resulted in worse clinical outcomes and a significantly higher rate of growth disturbances (p=.03). DiscussionThis study confirmed the presence of growth disturbances following pediatric distal tibial fractures, especially in cases of high-energy trauma. Therefore, these fractures should be monitored until the end of the growth period. Level of evidenceIV; retrospective study.

Combining Salter-Harris and Dias-Tachdjian could be better at determining the prognosis of distal tibial physeal fractures

ObjectivesThe aim of this study is determining the factors that affect prognosis of distal tibial physeal fractures (DTPF) and analyzing whether Salter-Harris (SH) or Dias-Tachdjian (DT) classification is more predictive for outcomes. MethodsPatients treated for DTPF were retrospectively analyzed. Fracture patterns were classified according to SH and DT. Treatment methods and fracture characteristics were noted. Distal tibial angles and joint irregularities were analyzed on patient's final ankle radiographs followed by American Orthopedic Foot and Ankle Score questionnaire. Results75 patients followed-up between 6 and 96 months meeting the inclusion criteria were evaluated. Joint irregularity was observed in 41.3% and partial premature physeal closure (PPC) in 34.7% of the patients. Lateral distal tibial angle (LDTA) and talocrural angle related deformity were detected in 20% and 14.7% of the patients, respectively. Partial PPC and joint irregularities that have been developed in pronation-eversion-external rotation and supination-inversion injuries (SH type 3, 4) were 62% and 50%, and 42% and 75%, respectively. On follow-ups of supination-external rotation injuries (SH type 2) joint irregularity has never been observed. Following supination-external rotation and supination-plantar flexion injuries, a low rate of partial PPC have been developed; LDTA related deformity was revealed at a high rate of 39.1% after supination-inversion injuries. There weren't any differences observed between the initial displacement, residual displacement or surgical technique and PPC, joint irregularity and angular deformities. Patients treated by ORIF technique had lower AOFAS scores than patients treated by other surgical techniques. ConclusionsIn this study it was revealed that SH classification system is not sufficient alone to determine the prognosis of DTPF, the injury mechanisms causing SH types might be also significant in prediction of the prognosis of DTPF.

Knee Trauma.

Knee Trauma.

Hip Dislocation and Subluxation in Athletes: A Systematic Review

Background: Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose: To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. s and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. Results: A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion (P = .015 and .068, respectively), increased prevalence of a cam deformity (P < .0035), higher alpha angles (P≤ .0213), and decreased posterior acetabular coverage (P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). Conclusion: Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

Approach to Suspected Physeal Fractures in the Emergency Department.

Growth plate (physeal) fractures are defined as a disruption in the cartilaginous physis of bone with or without the involvement of epiphysis or metaphysis. These represent around 15-18% of all pediatric fractures. It is important to diagnose physeal injury as early as possible, as misdiagnosis or delay in diagnosis may result in long term complications. Physeal injuries may not be initially obvious in children who present with periarticular trauma, and a high index of suspicion is important for diagnosis. Differential diagnosis for a Salter-Harris fracture includes a ligamentous sprain, acute osteomyelitis, or an extraphyseal fracture such as a Torus fracture. Salter-Harris I & Salter-Harris II growth plate fractures commonly are commonly managed by closed manipulation, reduction & immobilization. These are relatively stable injuries and can be retained by adequate plaster. Salter-Harris III & Salter-Harris IV fractures require anatomical reduction with the maintenance of congruity of joint. Physeal fractures can have many complications such as malunion, bar formation, acceleration of growth of physis, posttraumatic arthritis, ligament laxity and shortening of the bone. The key to well-healing fractures is successful anatomic reduction and patients must have regular follow-up for these injuries.

Percutaneous Pinning for Recent Lower Tibial Epiphyseal Injury in Pediatric

Background: Physeal fractures of long bones are common injuries treated by orthopedists. Distal tibial physeal fractures account for 11% of all physeal injuries. Objectives: The aim of the work is evaluation of the clinical and radiological outcome of lower tibial epiphyseal injury managed by percutaneous pinning. Patients and Methods: This was a prospective randomized study carried out on 12 cases with distal tibial epiphyseal injuries admitted to Zagazig University with follow up period up to six months. The youngest patient was 8 years old, while the oldest was 16 years old, with an average of 12 years; the high incidence was in the age group 10-15 years. Results:Overall results obtained from 12 cases were satisfactory in 11 cases (91.66%) and unsatisfactory in 1 cases (8.37%). More satisfactory results in this work were in the age group 10-15 years. However, age did not affect the results significantly. Cases with closed injury showed more satisfactory results (100%) than those with open injury, the difference was statistically highly significant. All cases in this study were presented within the first 48 hours from onset of trauma. 8 cases were immobilized for 8 weeks and 4 cases for 6 weeks. The difference was statistically insignificant. 2 cases were managed by open reduction and internal fixation and the difference was statistically insignificant. Conclusion: The percutaneous pinning for lower tibial epiphyseal injury showed good reduction of fracture, satisfactory functional outcome and less complications. The technique provided speed recovery, secure fixation and avoiding prolonged cast immobilization and conservative treatment.

Management of Salter-Harris II distal femur fractures - what is the state of practice? A survey of Pediatric Orthopaedic Society of North America membership.

Level V Expert Opinion.

A review of minimally invasive fracture stabilization in dogs and cats.

ObjectiveTo summarize and discuss peer‐reviewed studies on minimally invasive osteosynthesis (MIO) of long bone, physeal, and articular fractures in dogs and cats.Study DesignInvited review.MethodsA critique of literature was performed to assess MIO feasibility, outcomes, and complications through PubMed, Scopus, and CAB abstracts research databases (2000–2020).ResultsMore than 40 MIO articles have been published in the last 15 years, but most studies had small numbers, lacked control groups, and used limited outcome measures. Studies generally showed that MIO was feasible in dogs and cats with low complication rates. The current evidence does not demonstrate superior bone healing or functional outcomes with MIO when compared to standard methods. Although treatment principles, case selection, and techniques varied depending on the anatomical location, there were no salient differences in complication rates among long bones, physeal, and articular fractures treated by MIO.ConclusionThe current available evidence and the personal experience of the authors support MIO as a promising fracture management modality. MIO can yield excellent outcomes when applied in carefully selected cases, performed by surgeons experienced in the technique. We cannot, however, conclude that MIO is superior to open fracture stabilization based on the available evidence in veterinary literature. Randomized controlled studies are warranted to prospectively compare MIO with other osteosynthesis techniques and thereby validate its role in fracture management for dogs and cats.

Progressive Arterial Insufficiency in a Displaced Salter-Harris Type 1 Distal Femoral Fracture: A Case Report.

A 17-year-old male patient presented with Salter-Harris type I hyperextension injury of left distal femur with delayed development of acute limb ischemia secondary to popliteal artery injury. Popliteal artery injury associated with distal femoral physeal fracture may not be clinically obvious at the time of initial presentation. When initial pulse examination and segmental Doppler measurements are normal, it is important to perform serial examination by experienced examiners because arterial insufficiency may develop over the subsequent 48 hours. If unidentified, this can lead to significant disability and/or limb loss. This emphasizes the importance of serial monitoring along with judicious use of ankle brachial pressure index, pulse oximetry, and imaging.

Premature Physeal Closure after a Non-Displaced Physeal Fracture of Distal Fibula

Premature physeal closure (PPC) may lead to clinically significant progressive angular deformity or leg length discrepancy. Many variables seem to play a role in determining which injuries result in PPC. A 8- year-old boy sustained a non-displaced physeal fracture of distal tibia and fibula. He showed no signs of PPC at 7 months post-injury. Seven years later, his ankle became painful. He had developed PPC of distal fibula causing angular ankle deformity, which was treated successfully by corrective osteotomy. To our knowledge, this is the first reported case of a non-displaced fracture of the distal fibula leading to PPC several years after the initial injury, which in our understanding was impossible to predict.

Inter-rater and Intra-rater Reliability in the Radiographic Diagnosis of Growth Arrest in Paediatric Physeal Fractures

BackgroundFractures through the physis account for 18–30% of paediatric fractures and can lead to growth arrest in 5–10% of these cases. Long-term radiographic follow-up is usually necessary to monitor for signs of growth arrest at the affected physis. Given plain radiographs of a physeal fracture obtained throughout patient follow-up, different surgeons may hold different opinions about whether or not early growth arrest has occurred despite using identical radiographs to guide decision-making. This study aims to assess the inter-rater and intra-rater reliability of early growth arrest diagnosis among orthopaedic surgeons given a set of identical plain radiographs.MethodsA retrospective chart review was conducted on patients aged 2–18 years previously treated for a physeal fracture at a paediatric tertiary care hospital between 2011 and 2018. De-identified anteroposterior (AP) and lateral radiographs of 39 patients from the date of injury and minimum one-year post-injury were administered in a survey to international paediatric orthopaedic surgeons. Each surgeon was asked whether they would diagnose the patient with growth arrest based on the radiographs provided. Surgeons were asked to complete this process again two weeks after the initial review, but using identical shuffled radiographs. Inter-rater and intra-rater reliability was calculated using appropriate kappa statistics.ResultsA total of 11 paediatric orthopaedic surgeons completed the first round of the survey, and 9 of these 11 completed the second round. The inter-rater reliability for the first round was 0.22 [95% CI (0.06, 0.35)] and 0.21 [95% CI (0.02, 0.32)] for the second round. The average kappa for intra-rater reliability was − 0.05 [95% CI (− 0.31, 0.21)]. Comparison by injury side showed no significant variation in diagnosis {p = 0.509, OR = 0.90, [95% CI (0.67, 1.22)]}, while comparison by location of injury varied significantly (p = 0.003).ConclusionsRadiographic diagnosis of growth arrest among paediatric orthopaedic surgeons demonstrated ‘fair’ inter-rater agreement and no intra-rater agreement, suggesting critical differences in identifying growth arrest on plain radiographs. Further research is necessary to develop an improved diagnostic approach for growth arrest among orthopaedic surgeons.Level of EvidenceDiagnostic level III.

CPD article: Fractures of the femur

Femoral fractures occur commonly in dogs and cats, accounting for 45% of all long bone fractures. Femoral fractures are classified based on anatomic locational and include fractures of the proximal epiphysis, proximal physeal fractures, subcapital fractures, fractures of the femoral neck, trochanteric fractures, subtrochanteric fractures, fractures of the femoral shaft, supracondylar fractures, distal physeal fractures, unicondylar fractures, bicondylar fractures and fractures affecting the femoral trochlea. In general, femoral fractures are not amenable to treatment with external coaptation, so surgical stabilisation or a salvage procedure is required. Selection of an implant system will depend on fracture configuration and location, and requires a thorough understanding of the forces to which the implant system will be subjected. Complications associated with stabilisation may include premature physeal closure, resorption of the femoral head or neck, malunion, non-union, altered coxofemoral development, implant failure, sciatic neurapraxia, quadriceps contracture, patellar luxation and infection. The complication rate can be substantially reduced by the use of meticulous surgical technique and appropriate implant selection with the prognosis for complete functional recovery remaining good to excellent, providing that an optimal healing environment is preserved.

Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years

ObjectiveInvestigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons.MethodsAll injuries that caused time-loss or required medical attention (as per...

Traumatic physeal fractures in cats: a review of 36 cases (2010-2020).

The aim of this study was to describe the demography, aetiology, location and classification of physeal fractures in cats, and to describe their management and outcomes. Clinical records and radiographs of cats referred for management of physeal fractures were retrospectively reviewed. Fractures of the proximal femoral physis were excluded. Descriptive statistics were used to describe signalment, cause of injury, presence of concurrent injuries, fracture description, treatment modality, complications, follow-up, physeal closure, implant removal and outcome. Thirty-four cats with 36 fractures were included, of which 17 affected the distal femur, 11 the distal tibia and fibula, five the distal radius and ulna, two the proximal tibia and one the distal humerus. Salter-Harris classification was type I in 14, type II in 16, type III in two and type IV in four fractures. Thirty-four fractures were treated with primary fixation, and the most common method was crossed Kirschner wires (24/34 fractures). Complications were observed in 14 fractures, of which 12 were minor. At radiographic follow-up, physeal closure was reported in 23 fractures, of which 15 were considered premature. Implant removal was performed in three fractures. Outcome was good in 28, fair in four and poor in two fractures. Fracture of the distal femoral physis was the most common physeal fracture seen. Cats presenting with physeal fractures may be skeletally immature or mature with delayed physeal closure. The rate of physeal closure after fracture repair was relatively high but without apparent impact. The frequency of implant removal was very low, indicating that despite having a physeal fracture repair, most cats did not require a second procedure to remove implants. Overall, internal fixation provided a good outcome in most fractures.

Screw Fixation of Pediatric Tibial Tubercle Fractures.

Tibial tubercle fractures are rare injuries that account for <1% of physeal fractures. These fractures are thought to be increasing in frequency, particularly in young, adolescent males who participate in basketball and other sports with repeated running and jumping. The tibial apophysis becomes mechanically vulnerable as the proximal tibial physis closes from posteromedial to anterolateral, enabling the quadriceps to overpower the chondroepiphysis and avulse the proximal tibial epiphysis from the tibial metaphysis. Position the patient supine with the leg on a bump or bone foam. Perform a longitudinal incision centered over the fracture site (i.e., the tibial tubercle); a medial parapatellar incision may be utilized if an intra-articular component is present. Develop medial and lateral soft-tissue flaps to expose the fracture. Evaluate the soft-tissue stripping and capsule. Debride any hematoma, fracture fragments, and soft tissue from the fracture site with use of irrigation and a curet. Use a towel clip, bone clamp, and/or ballpoint pusher to reduce the fragment. Place 2 to 3 parallel guide pins from anterior to posterior, capturing fracture fragments within the epiphysis and apophysis under fluoroscopic guidance. Carefully place a guidewire in the distal fragment to avoid splitting the fragment, which is often small. An arthrotomy or arthroscopy is utilized to assess intra-articular reduction if necessary. Assess and measure pin lengths and placement with use of fluoroscopy. Place screws sequentially to avoid rotation of the fragment and take care to avoid splitting the fragment when placing distal screws. Repair any patellar, capsular, retinacular, or meniscal damage. A suture anchor may be utilized to repair the patellar tendon if necessary. The skin is closed in a layered fashion. Apply a cylinder cast or hinged knee braced locked in extension. Nonoperative treatment in a long-leg cast in extension may be considered for nondisplaced fractures or fractures that are stably reduced with <2 mm of displacement and acceptable alignment in the cast following reduction. Operative treatment is indicated for fractures with ≥2 mm of displacement, intra-articular extension with an incongruent joint, and for patients who will not tolerate being non-weightbearing in a cast. Closed reduction is generally attempted for fractures without intra-articular extension. If closed reduction is successful, fixation may be performed with Kirschner wires and/or percutaneous screws. Open reduction is often necessary and has been reported to be performed in as many as 98% of surgical cases for tubercle fractures2. This approach allows access to intra-articular displacement and the ability to obtain a stable, anatomic reduction while addressing concomitant soft-tissue injury, if present. The expectation following successful reduction and screw fixation of tibial tubercle fractures is that these young patients will be able to regain their motion and strength, and ultimately return to preinjury activity levels. A consecutive series of 86 patients with surgically treated tibial tubercle fractures found that all patients demonstrated full radiographic healing at the time of the latest follow-up (range, 3 to 34 months), return to full activities between 10 and 42 weeks, return of good to excellent range of motion in 89% of patients, and a 10% to 20% complication rate, including partial physeal arrest, decreased range of motion, quadriceps contracture, and painful implants. Additionally, a systematic review of 23 articles with 336 surgically treated tibial tubercle fractures found 98% of patients return to preinjury activity and knee range of motion with a 28% complication rate (most commonly due to painful implants). Place the fluoroscopic image view across the room from the surgeon for ease of viewing.Use computed tomography or magnetic resonance imaging if the fracture has intra-articular extension.Use 4.5 or 6.5-mm cannulated, partially threaded screws.Carefully monitor for compartment syndrome.Place screws by hand, sequentially.

What are the risk factors and presenting features of premature physeal arrest of the distal radius? A systematic review.

Premature physeal arrest (PPA) of the distal radius is considered a rare complication of physeal wrist fractures. Standardised guidelines for duration of follow up do not exist. The aim of this review is to recognise the risk factors of PPA and guide follow up protocols. The secondary aim is to understand the typical presenting symptoms of PPA. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, the Cochrane Library, and grey literature were searched from inception to October 2020. Studies included were: (i) original articles, (ii) distal radius physeal injuries, (iii) with at least a partial study population that developed PPA. Thirteen studies were included with 616 physeal injuries. There were 114 PPAs reported with a mean age at time of injury of 10.6years (1-16). The rate of PPA with radiological follow up was 7-23%. Intraarticular fractures and repeated manipulations increased the rate of PPA. K-wire fixation, open reduction and malunion did not. The most common presenting symptom of PPA was: pain (70%), deformity (55%), restricted range of movement (40%), reduced grip strength (40%) and snapping or clicking (30%). All patients with radial shortening of 10mm or more were symptomatic. There were no risk factors that reliably predicted all PPA. The majority of patients who develop PPA will remain asymptomatic until significant shortening or deformity have occurred. We recommend a minimum of 18months radiological follow up for every distal radius physeal injury.

Zürich cementless total hip arthroplasty as a treatment option for capital physeal fractures in dogs: Outcome in 53 cases

To review the outcome of dogs that underwent Zürich cementless total hip arthroplasty (Z-THA) for the repair of acute and chronic capital physeal fractures (CPF) and document the CPF-related hip remodeling. Retrospective study. Fifty-three Z-THA in 53 dogs. Medical records of dogs (2006-2019) that underwent Z-THA for CPF management were reviewed. Dogs were divided into two groups on the basis of the days elapsed between CPF diagnosis and Z-THA, acute (≤30 days) and chronic (>30 days). Hip remodeling variables were determined from preoperative radiographs or intraoperatively. Descriptive statistics were performed, and the complication rates, outcome, and coxofemoral remodeling were recorded. Comparisons of remodeling variables and rates between groups were performed by using Fisher's exact test. In total, 23 of 53 (43.4%) cases were acute, and 30 of 53 (56.6%) cases were chronic. There was no difference in the femoral remodeling rates between the acute and chronic groups (P=.184), whereas acetabular remodeling was more prevalent in the chronic group (P < .001). Intraoperative complications occurred in four of 53 (7.5% [1/23 acute, 3/30 chronic]) cases, and postoperative complications occurred in six of 53 (11.3% [2/23 acute, 4/30 chronic]) cases. Good clinical outcomes were achieved in 51 of 53 (96.2% [21 acute, 30 chronic]) cases. Complication rates of Z-THA for CPF repair were similar to the complication rates reported for Z-THA of dysplastic hips. Hip remodeling was common regardless of CPF chronicity. Zürich cementless total hip arthroplasty is viable for surgical management of CPF. There is a high likelihood that hip remodeling will be encountered, even in fractures treated within 30 days of presenting for hind limb lameness.

Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents.

. This study performed to investigate the incidence of growth arrest such as leg length discrepancy (LLD) and ankle joint angular deformity and its risk factors after physeal fracture of the distal tibia in children and adolescents. . Consecutive 78 patients (mean age 11.4 ± 2.0 years; mean follow-up period 2.0 ± 1.2 years) treated for the distal tibia physeal fracture were included. All patients underwent preoperative ankle radiographs, three-dimensional computed tomography (CT) scans, and postoperative follow-up teleradiogram. Patients were divided into two groups according to the LLD and the difference of lateral distal tibial angle (LDTA) with the contralateral limb as follows: Group 1 (growth arrest), patients with LLD ≥ 1cm or difference of LDTA ≥ 5°; Group 2 (normal growth), patients with LLD < 1cm and difference of LDTA < 5°. . The overall incidence of growth arrest was 12.8% (10 of 78). The mean displacement measured using CT scan was 4.4 ± 3.2 mm (range, 0.8-14.9). Of the total 78 fractures, 65 were treated surgically and 13 fractures were treated conservatively. The initial fracture displacement was significantly different between the two groups (p<0.001). However, there were no statistically significant differences between the two groups with respect to other factors. Initial displacement was the only significant risk factor for growth arrest (p<0.003). The cutoff values of initial displacement between the two groups were 5.2mm. . This study showed that degree of initial displacement was the only significant risk factor for growth arrest after physeal fracture of the distal tibia in children and adolescents. Therefore, physicians should consider the possibility of growth arrest for patients with severely displaced physeal fractures of the distal tibia.

Management of Physeal Fractures: A Review Article.

Physis is the weakest structure in the skeleton of a child and a frequent site of an injury or fracture. A physeal fracture presents a unique challenge in the management as the sequalae of such an injury could lead to growth disturbances. In this review, mainly focussing on traumatic physeal injuries, the authors discuss the applied anatomy, different fracture patterns, clinical assessment and management of physeal fractures in children. Discussion on acute physeal injuries as well as physeal arrest and approach to its management is presented. Past attempts for treatment of physeal injuries and recent advances in their management is also discussed. The ideal approach to treat physeal injuries should take into account the location of injury, age of the patient, fracture type and growth potential of the involved physis. Prompt diagnosis and physeal-respecting treatment techniques are important.