Premature Physeal Arrest Research Articles

The efficacy of physeal bar resection with guided growth in the treatment of physeal arrest with angular limb deformity

Premature physeal arrest can cause progressive deformities and functional disabilities of the lower limbs. This study addressed the outcomes after physeal bar resection with or without guided growth (temporary hemiepiphysiodesis) for the treatment of angular limb deformities. We retrospectively analyzed 27 patients (mean 9 years; range, 3–12 years) who underwent physeal bar resection of the distal femur (15 patients), proximal tibia (3 patients), and distal tibia (9 patients) between 2002 and 2020. Fifteen patients underwent physeal bar resection only (Group A), and the other twelve underwent simultaneous guided growth (Group B). The correction angle (angle change between the preoperative and last follow-up values) was compared and analyzed. The overall mean correction angle was 2.9° (range, − 9 to 18.3°). A total of 12 (45%) patients had a > 5° angular deformity improvement (mean, 9.6°; range, 5–18.3°), 9 (33%) had a < 5° angular change; and 6 (22%) had a > 5° worsening of the angular deformity (mean, 6.7°; range, 5.2–9°). The correction angle in Group B (mean 7.6° ± 6.2) was significantly higher than that in Group A (mean − 0.77° ± 6.3) (P = 0.01). We found six (40%) and zero patients with a > 5° angular deformity increase in Groups A and B, respectively (P < 0.047). The group that underwent physeal bar resection with guided growth showed significantly higher correction angles than the group that underwent physeal bar resection alone. Additionally, none of the patients in the guided growth group experienced an increased angular deformity. Therefore, combining guided growth with physeal bar resection may lead to better outcomes in the treatment of growth arrest with angular deformities.

Physeal Fractures of the Distal Ulna: Incidence and Risk Factors for Premature Growth Arrest.

The aim of this study is to assess the rate of distal ulnar growth arrest following physeal fracture and to identify specific risk factors for premature physeal closure. A retrospective review of patients with a distal ulnar physeal fracture was performed at a single United States children's hospital. Patients without 6-month follow-up were excluded. Patient demographics, injury characteristics, treatment, and outcomes were abstracted. Fractures were classified by the Salter-Harris (SH) system. All follow-up radiographs were reviewed for changes in ulnar variance or signs of premature physeal arrest. Fifty-six children with distal ulnar physeal fracture at a mean age of 10.7±3.3 years were included with a mean follow-up of 1.9 years. The most common fracture pattern was a SH II (52.7%), versus SH I (29.1%), SH III (9.1%), and SH IV (9.1%). Of displaced fractures (41.1%), the mean translation was 40.2±38.3% the and mean angulation was 24.8±20.9 degrees. Eleven fractures (19.6%) demonstrated radiographic signs of growth disturbance, including 3 patients (5.4%) with growth disturbance but continued longitudinal growth and 8 patients (14.3%) with complete growth arrest. The average ulnar variance was -3.4mm. Three patients underwent subsequent surgical reconstruction including ulnar lengthening with an external fixator, distal ulna completion epiphysiodesis with distal radius epiphysiodesis, and ulnar corrective osteotomy. Patients with displaced fractures and SH III/IV fractures were more likely to develop a growth disturbance (34.8% vs. 3.2%, P =0.003; 50.0% vs. 11.1%, P =0.012, respectively). Children with less than 2 years of skeletal growth remaining at the time of injury had a higher risk of growth disturbance (46.2% vs. 9.5%, P =0.007). SH III and IV fractures are more common injury patterns in the distal ulna compared with the distal radius. Growth disturbance or growth arrest occurs in ~20% of distal ulnar physeal fractures. Displaced fractures, intra-articular fractures, fractures requiring open reduction, and older children are at increased risk of distal ulnar growth arrest and should be followed more closely. Level IV--case series.

Pathological fracture increases the risk of unsatisfactory functional results and avascular necrosis in children with proximal femur simple bone cysts

IntroductionProximal femur simple bone cysts (SBCs) are rare in children, but with a risk of pathological fractures and the associated poor outcomes. This study aimed to evaluate the functional and radiographic outcomes of children with proximal femur SBCs. Patients and Methods38 children with proximal femur SBCs treated surgically at our department, West China hospital, were enrolled in the study. Patients were divided into two groups according to whether pathological fractures presented before treatment. The non-fracture group received treatment of open curettage, cavity electrocauterization, bone grafting, and fixation (proximal femoral plate, intramedullary nail or Kirschner wire). The pathological fracture group received the same procedures of curettage, electrocauterization, grafting, and fixation. Autogenous iliac bone grafting was done in all cases, and the artificial bone was used as a supplementary based on the size of the cavity. Postoperatively, all patients underwent hip spica or similar orthosis immobilization for six weeks and received the same rehabilitation program after the removal of hip spica. Patients were evaluated by two independent observers, including the functional results based on the Ratliff's criteria, avascular necrosis, healing rate based on the Neer scoring system, coxa vara, and premature physeal arrest. We described the good outcome in Ratliff's criteria as “Satisfactory results”, and fair and poor outcomes as “Unsatisfactory results.” Grade 1 and grade 2 Neer results were termed as failures in treatment, and grades 3 and 4 were considered successes and healing. Results38 patients with 38 hips (18 on the left side and 20 on the right side) were evaluated, including 9 females and 29 males, with a mean age of 9.0±2.6 years old (range, 5 to 14 years). There was no significant difference between these two groups in the baseline data of gender, age, side, grafting, staging, and fixation methods. The rate of unsatisfactory functional results in the pathological fractures group was 56.3% (9/16), significantly higher than that in patients without fracture (22.7%, 5/22. p= 0.047). There was also a significant difference in avascular necrosis of the femoral head between the pathological fractures group (7/16) and the group without fracture (2/22, p=0.021). Thirty cases presented with healing, including 13 in the fractures group and 17 in the non-fracture group (p=1.000), and eight cases were graded as failures (2 cases of grade 1 and 6 cases of grade 2). There were also no significant differences between these two groups in premature physeal arrest (2 in fracture group and 1 in non-fracture group, P=0.562), and Coxa vara (3 in the fracture group and 0 in non-fracture group, P=0.066). ConclusionsPathological fracture significantly increases the risk of unsatisfactory functional results and avascular necrosis of the femoral head in patients with femoral neck SBCs. Prophylactic treatment and fixation of SBCs in weight bearing proximal femur region is better to manage without complications than managing with pathological fractures.

Three-dimensional Gait Analysis Spanning 13 Years in a Patient with Unilateral Premature Physeal Arrest: A Case Report

Three-dimensional Gait Analysis Spanning 13 Years in a Patient with Unilateral Premature Physeal Arrest: A Case Report

THROWER’S ELBOW: OUTCOMES AND RECURRENCE OF ELBOW PAIN IN PEDIATRIC ATHLETES

Purpose: Thrower’s Elbow (TE) is an overuse injury of the medial elbow in pediatric, throwing athletes. The purpose of this study is to report the outcomes of TE in pediatric, throwing athletes. Methods: Between 1996 and 2018, 30 athletes at an average of 12.2 years old (range: 7.9 to 15.4 years old) were treated for TE. Demographic, radiographic, and treatment variables were recorded. Outcome measures included return to original position, inability to return to sport, surgery, premature physeal arrest, and recurrence of elbow pain. Results: Prior to their initial presentation, 25 athletes (25/30, 86%) stated they continued to throw despite arm fatigue/pain. At an average follow-up of 26 months (range: 6 months to 122 months), 22 athletes (22/30, 73%) returned to their original position at an average five months from their initial presentation. Recurrence of elbow pain occurred in 27 athletes (27/30, 90%). No athletes had premature physeal arrest of the medial epicondyle. Conclusions: The majority of athletes with TE returned to their original position or sport after initial treatment, but 90% of those athletes developed recurrent pain. It is important to educate athletes about overuse throwing injuries and prevention by adhering to established guidelines.

Trochleoplasty in the Pediatric Population - A Systematic Review of Patient Characteristics, Treatment Strategies and Outcomes

Background:Trochleoplasty is a treatment considered for patellofemoral instability patients with high grade dysplasia and those who have failed other surgical intervention. However, the indications for and the safety profile of this procedure remain unclear, particularly in the pediatric population where concerns exist regarding physeal arrest and the development of premature patellofemoral arthritis.Purpose:To systematically review the literature to evaluate trochleoplasty use, outcomes and complications observed among pediatric patients.Methods:A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines reviewing Pubmed and SCOPUS databases. Inclusion criteria were studies including pediatric (<18yo) patients undergoing trochleoplasty with either a mean age <18 or those in which individualized patient characteristics and resultant outcomes were reported. Patient demographics, dysplasia type, procedure type and patient outcomes were abstracted when available and summarized with descriptive statistics.Results:Our search strategy identified 4 studies published from 2016-2020 that included 86 patients (mean age=14.5yo) with a mean follow up of 31.6 months (range 12-60 months). All were classified as Level IV evidence. The majority (65%) of patients were Dejour B (56/86). A thin-flap technique was used in three studies while a lateral wedge augmentation procedure was utilized in the fourth. Kujala and Lysholm scores were collected in two studies with demonstrable patient improvement. The most common early complication noted was arthrofibrosis requiring arthroscopic lysis of adhesions (5 total patients). Only a single recurrent instability event was reported. In a single study, 4 of 23 patients had radiographic trochlear osteoarthritic changes at 5 years postoperatively. There were no reports of premature physeal arrest in two studies that monitored for this outcome.Conclusion:There remains a limited evidence base regarding trochleoplasty use in pediatric patients. Overall, favorable outcomes have been observed with infrequent recurrent instability. There are no reports of growth disturbance from physeal arrest as a result of this procedure identified, but reporting among patients with confirmed skeletal immaturity is scarce. Patellofemoral arthritic changes were observed radiographically in a small subgroup of patients, but further work is necessary to determine if this is a result of the procedure itself or the underlying pathology being treated. As interest grows in implementing trochleoplasty in the pediatric population and potentially skeletally immature individuals, improved evidence is necessary to determine the incidence of major complications in order to better define the safety profile and indications for use in children and adolescents.

Lower Tibial Shaft Spiral Fracture Concurrent with Distal Tibial Triplane Fracture

Background: The clinical and imaging features of lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture are not clear. Introduction: This study was conducted to investigate these features for correct diagnosis, treatment and prevention of possible premature physeal arrest or angular deformation. Method: Patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were enrolled, and the clinical, imaging, treatment and follow-up data were analyzed. Result: Five patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were found including four men and one woman with an age range of 12-15 years (mean 13.6). Injury to the distal tibial epiphysis was missed in the diagnosis in plain radiography reports, but careful reevaluation confirmed distal tibial epiphysis fracture in four cases including Salter-Harris type II in three cases and type III in one case. The remaining case had no apparent distal tibial epiphysis injury in the plain radiograph. CT scan revealed that all five patients had distal tibial triplane fracture of the lateral type including two fragments in three cases and three fragments in two cases. The fracture was divided into type I(within the articular weight-bearing line) in three cases, type II (outside the articular weight-bearing line) in two cases based on the involvement of the articular surface by the fracture line. For the lower tibial fracture, one patient was treated with closed reduction and fixation with an elastic nail, three patients had internal plate fixation, and the remaining patient had cast immobilization. Followed up for 3-11 months (mean 7), all the distal tibial fractures and the triplane fractures were healed without varus or valgus deformity in the ankle. Conclusion : Distal tibial triplane fracture can be readily missed in plain radiography and should be suspected in patients with distal tibial spiral fracture which should be evaluated with a computed tomographic scan.

Proximal Tibial Opening Wedge Osteotomy for the Treatment of Posterior Knee Instability and Genu Recurvatum Secondary to Increased Anterior Tibial Slope

Decreased posterior tibial slope has been associated with increased risk of graft failure and knee instability after posterior cruciate ligament (PCL) reconstruction. Premature physeal arrest at the tibial tubercle is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prolong the integrity of the PCL graft. This article discusses our preferred treatment using a proximal tibial opening wedge osteotomy for surgical management of posterior knee instability and genu recurvatum secondary to significant anterior tibial slope.

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.

The midterm outcomes of ankle Dias-Tachdjian pronation-eversion external rotation physeal fracture in children treated by open reduction internal fixation with one-stage medial-lateral combined incision.

The objective of this study was to report the midterm outcomes and complications of ankle Dias-Tachdjian pronation-eversion external rotation (PEER) physeal fracture in children treated by ORIF with combined medial and lateral incision. A total of 21 children with ankle Dias-Tachdjian PEER physeal fracture underwent open reduction internal fixation treatment with combined medial and lateral incision between January 2015 and October 2017. The lateral distal tibia angle (LDTA) was measured to evaluate angular deformity and the X-rays were taken to evaluate the premature physeal arrest. All patients were followed up for an average time of 20.1 months (ranging from 17 to 25 months). Bone healing was achieved in all cases. American Orthopedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) score of the patients improved from median 31 (11, 38) preoperation to median 68 (63, 73) postoperation to median score 91 (87, 96) at last follow-up. LDTA of the patients improved from 70.5 ± 4.9 preoperation to 90.0 ± 1.2 postoperation, to measure 90.6 ± 3.7 at last follow-up. The differences were statistically significant (P < 0.05). There is no premature physeal closure, ankle deformity in 19 cases. They could normally exercise and take part in normal sport activities. The remaining two cases had physeal bone bridge and premature physeal closure but could still carry on daily activities and thus were categorized as good. ORIF with one-stage medial-lateral combined incision for ankle Dias-Tachdjian PEER physeal fracture can decrease the rate of premature physeal closure and should be a treatment choice.

Pediatric Seymour Fractures of the Toe.

Seymour fractures of the toe are physeal fractures with often occult concomitant nail bed injuries and thus are open fractures. They are uncommon injuries that without proper treatment can result in osteomyelitis. The literature has sparse information regarding the clinical outcomes for these injuries. A single-center retrospective review included juxta-epiphyseal fractures or Salter-Harris I/II fracture of the toe with documented concomitant nail bed injury or laceration. Clinical and radiographic data were recorded for consecutive fractures. The primary outcome was the incidence of osteomyelitis. Secondary outcomes included premature physeal arrest, development of nail dystrophy, and functionality of the toe. Between 2006 and 2019, 19 patients were treated for this injury by the pediatric orthopaedic division. Complications included osteomyelitis (n=6), physeal arrest (n=4), and nail dystrophy (n=1). Days from injury to definitive treatment were significantly greater in patients who developed osteomyelitis compared with those who did not (P<0.01). Patients were significantly more likely to develop osteomyelitis if they did not receive acute definitive treatment (<48 h) (P<0.001; likelihood ratio, 17.9). Prompt definitive treatment of Seymour fractures of the toe was associated with a lower incidence of osteomyelitis. Greater awareness for these seemingly innocuous injuries is needed to provide an early treatment that may reduce the rate of osteomyelitis. Level IV-case series.

Fractures of the Proximal Femur in Childhood: A Review.

Femoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications. To review the current knowledge, discuss controversial aspects, and provide suggestions for future research. We have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed. There is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries.

Complications After Pediatric Hip Fractures: Evaluation and Management.

Pediatric proximal femur fractures are high-energy injuries with predictable and morbid complications. Osteonecrosis of the femoral head is the most common complication with identified risk factors including fracture type, patient's age, degree of displacement, timing to reduction, and stability of fixation. Additional complications include nonunion, coxa vara, and premature physeal arrest. The mainstay of treatment for traumatic pediatric osteonecrosis is hip preservation with total hip arthroplasty being reserved as a salvage procedure. An anatomic fracture reduction and a biomechanically stable construct are critical to prevent both nonunion and osteonecrosis. This review will look at the individual surgical interventions for the management of the associated complications of pediatric proximal femur fractures.

The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Femoral Neck Fracture Pearls and Pitfalls.

Pediatric hip fractures are uncommon injuries but are associated with a high complication rate including avascular necrosis, coxa vara, nonunion, and premature physeal arrest. This is due in part to the unique anatomy of the proximal femur. Management principles are aimed at minimizing the risk of complications and emphasize the importance of early treatment with anatomic reduction and stable internal fixation with a low threshold for supplementing fixation with a spica cast. The age of the patient and Delbet fracture type dictate the optimal type of fixation for a given case. This article will offer evidence and experience-based tips intended to benefit on-call surgeons caring for these injuries.

In Vivo Response of Growth Plate to Biodegradable Mg-Ca-Zn Alloys Depending on the Surface Modification

Because Mg-Ca-Zn alloys are biodegradable and obviate secondary implant removal, they are especially beneficial for pediatric patients. We examined the degradation performance of Mg-Ca-Zn alloys depending on the surface modification and investigated the in vivo effects on the growth plate in a skeletally immature rabbit model. Either plasma electrolyte oxidation (PEO)-coated (n = 18) or non-coated (n = 18) Mg-Ca-Zn alloy was inserted at the distal femoral physis. We measured the degradation performance and femoral segment lengths using micro-CT. In addition, we analyzed the histomorphometric and histopathologic characteristics of the growth plate. Although there were no acute, chronic inflammatory reactions in either group, they differed significantly in the tissue reactions to their degradation performance and physeal responses. Compared to non-coated alloys, PEO-coated alloys degraded significantly slowly with diminished hydrogen gas formation. Depending on the degradation rate, large bone bridge formation and premature physeal arrest occurred primarily in the non-coated group, whereas only a small-sized bone bridge formed in the PEO-coated group. This difference ultimately led to significant shortening of the femoral segment in the non-coated group. This study suggests that optimal degradation could be achieved with PEO-coated Mg-Ca-Zn alloys, making them promising and safe biodegradable materials with no growth plate damage.

Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

Background: ulnar impaction syndrome (UIS) is a common cause of ulnar-sided wrist pain. The differential diagnosis of ulnar-sided wrist pain is diverse due to the complex nature of the bony and soft tissue anatomy UIS may lead to degenerative lesions of the triquetrum, lunate, ulnar head cartilage or of the TFCC. Concomitantly the triquetrolunate ligaments may be disrupted. Associated factors of ulno-carpal joint space narrowing may include previous fracture (e.g. of the distal radius), premature physeal arrest of the distal radius or congenital ulna positive variance. Aim of the work: this study aimed to evaluate the outcome of treating ulnar impaction syndrome with ulnar shortening osteotomy upon clinical and radiological. Materials and Methods: in this study ten adult patients with ulnar impaction syndrome were selected from Orthopedic Outpatient Clinic of Faculty of Medicine (Damietta), Al-Azhar University Hospital from January 2018 to October 2018 and they were operated by ulnar shortening osteotomy and fixed by plating.Description of technique alongitudinal incision over the subcutaneous border of the ulna issued to expose the ulna between the distal and middle third of the ulna from the ulna styloid. Preoperative posteroanterior (PA) X-rays were reviewed to determine the amount of shortening required, with a goal of creating -2 mm variance postoperatively. A 6-hole dynamic compression plate was predrilled distally prior to performing two oblique osteotomies separated by the desired shortening length. The fragments were reduced and plated by using compression. Results: the mean disabilities of the arm, shoulder and hand (DASH) score was 9 postoperatively. Flexion, extension and supination were reduced compared to the contralateral unaffected extremity (84.6%, 85.3%, and 86.9% of normal). Patients received worker’s compensation 5 of 10 patients required hardware removal for plate irritation and 2 of 10 patients had a nonunion. Conclusion: we preferred our surgical technique ulnar shortening osteotomy for all cases of UIS. Pain was significantly improved in our Cases; however, smokers had less improvement in pain and higher disability scores.

Salter-Harris type II fracture of the femoral bone in an 8-year old boy- A Case Report

Introduction: Distal femur epiphyseolysis, i.e. separation of physis at the distal femur in the immature skeleton of children consists of physis displacement or fracture or both is rarely seen and is often associated with complications. Physeal fractures or dislocation (also known as knee dislocation) should be treated as a medical emergency usually within 6 hours of trauma by adequate reduction, stabilization and vascular injury repair in order to prevent pre-mature physeal closure, deformity and growth arrest thereby leading to limb length discrepancy. Case Report: Reported here is a rare case of Salter Harris type II fracture dislocation of the distal femur in an 8-year-old boy who presented to our hospital with swelling and flexion deformity of the left knee 15 days after trauma and was previously treated with slab application and immobilization at a rural health centre. Open reduction and internal fixation was performed with Kirschner wires. These were removed after 6 weeks. Post-operative evaluation after 4 months showed no deformity or limb length discrepancy. Radiograph was suggestive of adequate alignment and no bony abnormality. Conclusion: Although rare, distal femur epiphyseal injuries of the childhood are of a great concern because of the degree of bone deformities, growth disturbances and significant disabilities caused by them. A detailed study of the these type of injuries helps in deciding the treatment methods and procedures to be opted, which eventually affects the prognosis and outcome in such cases.

Fixation in slipped capital femoral epiphysis avoiding femoral-acetabular impingement

BackgroundThe appropriate treatment in mild slipped capital femoral epiphysis (SCFE) should not only prevent further slipping of the epiphysis but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. The aim of this study was to quantify length of the remodeling phase mediated by growth of the femoral neck, after treatment of SCFE with a screw designed to prevent premature closure of the physis and provide stability.MethodsBetween 2001 and 2011, 38 patients with unilateral mild SCFE were treated by fixation in situ using a modified screw which does not cause premature physeal arrest. Twenty-four patients were investigated for clinical and radiological evidence of femoroacetabular impingement immediately after surgery, at 6- and 12-month follow-ups. Statistical analysis was performed comparing measurements of neck length and the α angle of the affected and contralateral side.ResultsMean α angle immediately after pinning was 56.2 ± 10.6° on the anteroposterior view and 91.4 ± 8.2° on the lateral view. These measurements significantly improved at 6 months post-op to 48.9 ± 5.4° on the anteroposterior view and 51.2 ± 6.5° on the lateral view (p < 0.0001). At 12 months from surgery, AP view α angle was 43.0 ± 2.8° (p < 0.0001) and lateral view was 44.2 ± 4.1° (p < 0.0001). We observed a similar growth rate and speed of the femoral neck of both the affected and unaffected sides during the first year of treatment. The clinical results in all patients were rated as excellent.ConclusionOur data supports the use of a surgical technique that allows residual growth of the femoral neck following mild SCFE and permits restoration of the anatomy of the proximal femur while avoiding development of femoroacetabular impingement following mild SCFE.

Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures: A Systematic Review.

Despite the frequent occurrence of these injuries, we know little about the natural history of Salter-Harris II (SH II) distal radius fractures. We conducted a systematic review of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures. Systematic searches of the MEDLINE and Cochrane computerized literature databases and manual searches of bibliographies were performed. We reviewed both descriptive and quantitative data. Seven studies including 434 SH II fractures were reviewed. Two studies reported clinical outcomes based on patient age, but neither study described a statistical correlation between patient age and outcome. Two studies discussed the effect of age on radiographic outcome and reported higher rates of anatomic remodeling in children 10 years or younger. Two studies with long-term (average follow-up greater than 8 years) clinical results reported complication rates of 5%. Long-term follow-up of radiographic outcomes appeared in 4 studies with variable results. Five studies reported the frequency of premature physeal arrest after SH II fractures, with results ranging from 0% to 4.3%. Based on this review, no recommendations can be made as to what defines an acceptable reduction or which fractures would benefit from surgical intervention. Angular deformity seems to correct to an acceptable alignment in patients less than 10 years of age, but these younger patients seem to be at higher risk for symptomatic shortening if a growth arrest occurs. Redisplacement after reduction is fairly common, and other more severe complications such as pain, loss of motion, and nerve injury can occur.

Guided growth by a stainless-steel tubular plate

Guided growth using titanium tension band plates is an advancement in the correction of angular deformity. We applied two-hole stainless-steel one-third tubular plates for the same purpose. There were 14 deformities around the knees in eight children, mean age 10.8 years at operation. The success rate was 92.9% (13/14). The average correction rate per month was 0.59° in the femur and 0.65° in the tibia. No premature physeal arrest, overcorrection, or rebound phenomenon was observed. A stainless-steel plate is a safe and effective option for guided growth surgery in countries where only stainless-steel plates are available.