Management of growth arrest: Current practice and future directions

Dabash, Sherif; Prabhakar, Gautham; Potter, Eric; Thabet, Ahmed M.; Abdelgawad, Amr; Heinrich, Stephen D.

doi:10.1016/j.jcot.2018.01.001

Cited by 39 publications

(37 citation statements)

References 63 publications

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“…Growth arrest occurs in 5% to 10% of cases in patients with physeal fractures. 6 It is rare after pediatric hand fractures, and length discrepancy has fewer functional implications compared with the larger long bones, especially in the lower limbs. 7 Nevertheless, it is important to counsel patients and their parents of the potential sequelae of physeal injury, including shortening, angular deformity, and joint surface incongruity.…”

Section: Physismentioning

confidence: 99%

Pediatric Hand and Wrist Fractures

Liao

Chong

2019

Clinics in Plastic Surgery

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Hand and wrist fractures have been consistently reported as among the most common fractures in children. 1-3 They are 3 times more common in boys and peak in the teenage years (Fig. 1). 4 Forearm fractures compromise the largest proportion of fractures. 1 In the hand, the proximal phalanx and the fifth ray are the most commonly affected bone and digit, respectively (Fig. 2). 4 Distal phalangeal fractures tend to occur in toddlers starting to explore the world with their hands, making them susceptible to fingertip crush injuries from slammed doors. With increasing age, the distribution of fractures moves proximally, with median ages of 12 years for proximal phalanx fractures and 15 years for metacarpal fractures. This distribution corresponds to the increasing body weight and participation in sporting activities during the teenage years. CONSIDERATIONS IN THE PEDIATRIC POPULATION Epidemiologic studies generally use 17 years or 18 years of age as the limit for pediatric fractures. The unique considerations in the management of pediatric hand fractures, however, apply to children with open physes with the potential to remodel. In addition, the ability of a child to participate and cooperate in the management may Disclosure: The authors have nothing to disclose.

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Section: Physismentioning

confidence: 99%

Pediatric Hand and Wrist Fractures

Liao

Chong

2019

Clinics in Plastic Surgery

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“…In addition, future studies could examine the diagnostic accuracy of plain radiography and advanced imaging modalities like MRI and CT (i.e., which radiographically diagnosed growth arrests result in real growth arrests requiring treatment). It is also well known that growth disturbances can occur after good anatomic reduction in Salter-Harris Type III, IV, and V physeal fractures where the growth plate has likely been damaged at the moment of impact [15]. A retrospective study to evaluate the timing of reduction and its role in the development of growth arrest after injury may be of worthwhile investigation.…”

Section: Discussionmentioning

confidence: 99%

“…A sample of 39 radiographs of physeal fractures were evaluated by each participating surgeon. The types of physeal fractures included: distal humerus (6), distal radius ( 14), proximal radius (1), distal femur (1), distal tibia (15), and distal fibula (2). There were 20 left-sided injuries and 19 right-sided injuries.…”

Section: Demographicsmentioning

confidence: 99%

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

Banting

Schaeffer

Bone

et al. 2021

IJOO

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Background Fractures 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. Methods A 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. Results A 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). Conclusions Radiographic 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 Evidence Diagnostic level III.

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“…The incidence of the physeal injuries of distal fibula and the related risk of PPC is not known. PPC may lead to clinically significant progressive angular deformity or leg length discrepancy depending on its location and extent [8]. After physeal injury has been established, a repeat radiography is recommended every 3 months until normal growth has been documented for at least 6 months [8].…”

Section: Introductionmentioning

confidence: 99%

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

Laaksonen¹,

Kosola²,

Nietosvaara³

et al. 2021

SCR

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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.

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Management of growth arrest: Current practice and future directions

Abstract: The use of mesenchymal stem cells provides a promising alternative treatment modality.

Cited by 39 publications

References 63 publications

Pediatric Hand and Wrist Fractures

Pediatric Hand and Wrist Fractures

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

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

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