Analysis of Physeal Fractures from the United States National Trauma Data Bank

Abstract

Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation.

Epidemiology of Physeal Fractures and Clinically Significant Growth Disturbances Affecting the Distal Tibia, Proximal Tibia, and Distal Femur: A Retrospective Cohort Study

“…The presentation demographics of physeal fractures and fracture characteristics in the current study were consistent with previous studies. 7,8,[11][12][13][14] Physeal injuries were more common in males in this study cohort, as reported by others. 1,3,7,8,14 The average age of physeal injury to the distal tibia, proximal tibia, and distal femur was 11.3 years, which coincides approximately with the pubertal growth spurt.…”

“…7,8,[11][12][13][14] Physeal injuries were more common in males in this study cohort, as reported by others. 1,3,7,8,14 The average age of physeal injury to the distal tibia, proximal tibia, and distal femur was 11.3 years, which coincides approximately with the pubertal growth spurt. Kawamoto et al reported the mean ages of injury onset at 10.3 years in boys and 8.9 years in girls, and Peterson et al reported peak ages between 11 and 14 years.…”

“…The predominance of physeal injuries occurs in males, and the most common type of physeal fracture is classified as Salter-Harris (SH) Type II. 1,3,7,8 Physeal injuries peak between the ages of 11 to 14 years and are commonly sustained during involvement in organized sports. 7,8 Although upper extremity physeal fractures are the most common, physeal fractures of the distal tibia, proximal tibia, and distal femur have the greatest propensity for growth disturbances and complications such as growth arrest.…”

“…1,3,7,8 Physeal injuries peak between the ages of 11 to 14 years and are commonly sustained during involvement in organized sports. 7,8 Although upper extremity physeal fractures are the most common, physeal fractures of the distal tibia, proximal tibia, and distal femur have the greatest propensity for growth disturbances and complications such as growth arrest. 1,[9][10][11] SH classification and fracture displacement have been shown to be potential risk factors for complications necessitating surgical intervention in physeal fractures of the distal femur.…”

Advances in Pediatric Fracture Diagnosis and Treatment Are Numerous but Great Challenges Remain

“…In addition, two general studies provide insight into a broad pediatric fracture population. Fuchs et al [ 22 ] analyzed all physeal long-bone fractures registered in the United States in 2016. Almost 6% of pediatric long-bone fractures involved the physis.…”