Pediatric Juxtaepiphyseal Phalangeal Fractures Are Distinct from Salter-Harris Type II Fractures and More Frequently Need Operative Fixation

Abstract

Background: Salter-Harris type II fractures are the most common pediatric phalangeal fracture. A juxtaepiphyseal fracture is a distinct fracture pattern that, although similar in radiographic appearance, occurs 1 to 2 mm distal to the growth plate. Although subtle, there are important differences in the behavior and management of these fracture types. The purpose of this study was to compare these two fracture patterns in terms of clinical features and treatment. Methods: An institutional review board–approved retrospective chart review was conducted of patients presenting to our tertiary care pediatric hospital. One hundred fifty-eight patients with either Salter-Harris type II or juxtaepiphyseal phalangeal fractures were identified. Primary outcomes analyzed included angulation at initial presentation, stability of reduction if attempted in the emergency department, and need for operative fixation with and without Kirschner wire fixation, with final angulation measurements. Results: Salter-Harris type II fractures were more common than juxtaepiphyseal fractures (83 percent versus 17 percent, respectively). There was no significant difference between the two fracture types in the patient’s age, sex, or mechanism of injury. Juxtaepiphyseal fractures were radiographically more angulated on presentation than Salter-Harris type II fractures (p = 0.02). Juxtaepiphyseal fractures required significantly more operative fixation by closed reduction and percutaneous pinning compared to Salter-Harris type II fractures (42.9 percent versus 10.8 percent, respectively; p = 0.002). There was no difference in final outcomes obtained between the two groups. Conclusions: Juxtaepiphyseal phalangeal fractures are a distinct entity from Salter-Harris type II fractures. Presenting with significantly more radiographic angulation and clinical instability, juxtaepiphyseal fractures more frequently required operative fixation. Recognizing the differences between these pediatric fracture types is important to help guide clinical management for successful healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Biodegradable Dual-Cross-Linked Hydrogels with Stem Cell Differentiation Regulatory Properties Promote Growth Plate Injury Repair via Controllable Three-Dimensional Mechanics and a Cartilage-like Extracellular Matrix

“…Once damaged, cartilage tissue within the growth plate is usually repaired by undesirable bony bars, resulting in growth disturbances such as growth limitations or angulation deformities . Treatment modalities include bone bar removal and fat filling, osteotomy and realignment, or complete blockage of the remaining growth plate . However, such surgeries are highly invasive and yield limited benefits, highlighting the need for new strategies to prevent undesired bone bars and promote growth plate cartilage regeneration.…”

“…3 Treatment modalities include bone bar removal and fat filling, osteotomy and realignment, or complete blockage of the remaining growth plate. 4 However, such surgeries are highly invasive and yield limited benefits, highlighting the need for new strategies to prevent undesired bone bars and promote growth plate cartilage regeneration.…”