Combining Salter-Harris and Dias-Tachdjian Could be Better at Determining the Prognosis of Distal Tibial Physeal Fractures

Injury ◽  
2022 ◽  
Author(s):  
Alper OKTAY ◽  
Kubra Neslihan KURT OKTAY ◽  
Guven BULUT ◽  
Halil Ibrahim BEKLER
Keyword(s):  
Salter Harris ◽  
Physeal Fractures

scholarly journals Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773156 ◽  
Author(s):  
Andrew T. Pennock ◽  
Henry B. Ellis ◽  
Samuel C. Willimon ◽  
Charles Wyatt ◽  
Samuel E. Broida ◽  
...  
Keyword(s):  
Distal Femur ◽  
Femoral Condyle ◽  
Case Series ◽  
Injury Pattern ◽  
Advanced Imaging ◽  
Level Of Evidence ◽  
Physeal Fracture ◽  
Surgical Data ◽  
Salter Harris ◽  
Physeal Fractures

Background: Intra-articular physeal fractures of the distal femur are an uncommon injury pattern, with only a few small case series reported in the literature. Purpose: To pool patients from 3 high-volume pediatric centers to better understand this injury pattern, to determine outcomes of surgical treatment, and to assess risk factors for complications. Study Design: Case series; Level of evidence, 4. Methods: A multicenter retrospective review of all patients presenting with an intra-articular physeal fracture between 2006 and 2016 was performed. Patient demographic and injury data, surgical data, and postoperative outcomes were documented. Radiographs were evaluated for fracture classification (Salter-Harris), location, and displacement. Differences between patients with and without complications were compared by use of analysis of variance or chi-square tests. Results: A total of 49 patients, with a mean age of 13.5 years (range, 7-17 years), met the inclusion criteria. The majority of fractures were Salter-Harris type III fractures (84%) involving the medial femoral condyle (88%). Football was responsible for 50% of the injuries. The initial diagnosis was missed in 39% of cases, and advanced imaging showed greater mean displacement (6 mm) compared with radiographs (3 mm). All patients underwent surgery and returned to sport with “good to excellent” results after 2 years. Complications were more common in patients with wide-open growth plates, patients with fractures involving the lateral femoral condyle, and patients who were casted ( P < .05). Conclusion: Clinicians evaluating skeletally immature athletes (particularly football players) with acute knee injuries should maintain a high index of suspicion for an intra-articular physeal fracture. These fractures are frequently missed, and advanced imaging may be required to establish the diagnosis. Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with high rates of return to sport.

scholarly journals Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures

2016 ◽  
Vol 474 (11) ◽  
pp. 2531-2537 ◽  
Author(s):  
Daniel J. Cepela ◽  
Jason P. Tartaglione ◽  
Timothy P. Dooley ◽  
Prerana N. Patel
Keyword(s):  
Salter Harris ◽  
Physeal Fractures

scholarly journals Tibial tuberosity ossification predicts reoperation for growth disturbance in distal femoral physeal fractures

2020 ◽  
Vol 14 (4) ◽  
pp. 299-303
Author(s):  
James Kennedy ◽  
Dan Westacott ◽  
Mark Camp ◽  
Andrew Howard
Keyword(s):  
Femoral Fractures ◽  
Tibial Tuberosity ◽  
Growth Disturbance ◽  
Secondary Surgery ◽  
Level Of Evidence ◽  
Level Ii ◽  
Type Mode ◽  
Salter Harris ◽  
Reoperation Rates ◽  
Physeal Fractures

Purpose Distal femoral physeal fractures (DFPF) can cause growth disturbance that requires further surgical intervention. The aim of this study is to determine if Tibial Tuberosity Ossification Stage (TTOS) at the time of injury predicts secondary surgery for growth disturbance in patients who have sustained a DFPF. Methods We retrospectively investigated all patients who had operative treatment for a DFPF at a single centre over a 17-year period. Regression analysis was performed investigating associations between secondary surgery to treat growth disturbance and TTOS, age, Salter-Harris fracture classification type, mode of fixation or mechanism of injury. Results In all, 85 consecutive patients were identified. A total of 74 met the inclusion criteria. The mean age at time of injury was 13.1 years (2.0 to 17.1). Following fixation, 30 patients (41%) underwent further surgery to treat growth disturbance. Absence of tibial tuberosity fusion to the metaphysis was significantly associated with the need for further surgery (p < 0.001). Odds of requiring secondary surgery after tibial tuberosity fusion to metaphysis (compared with not fused) were 0.12 (95% confidence interval (CI) 0.04 to 0.34). The estimate of the effect of TTOS on reoperation rates did not vary when adjusted for gender, mechanism, fixation and Salter-Harris type. When accounting for age, the odds of any further operation if the tibial tuberosity is fused to the metaphysis (compared with not fused) were 0.28 (95% CI 0.08 to 0.94). Conclusion TTOS at the time of injury is a predictor of further surgery to treat growth disturbance in paediatric distal femoral fractures. Level of Evidence Diagnostic Level II

scholarly journals Classification of Distal Radius Physeal Fractures Not Included in the Salter-Harris System

2014 ◽  
Vol 8 (1) ◽  
pp. 219-224 ◽  
Author(s):  
Nikolaos K Sferopoulos
Keyword(s):  
Distal Radius ◽  
Classification Systems ◽  
Classification Schemes ◽  
Physeal Bar ◽  
Different Types ◽  
Salter Harris ◽  
Growth Abnormalities ◽  
Physeal Fractures

Introduction : The most commonly used classification for pediatric physeal fractures has been proposed by Salter and Harris. Among the most suitable classification schemes are those proposed by Ogden and Peterson who added several new types of injuries. The purpose of this study was to examine the value of both schemes to classify all different types of physeal injuries of the distal radius that are not included in the Salter-Harris system and to test a new nomenclature to classify and guide treatment for the whole spectrum of these injuries. Methods : A total of 292 children who were admitted for a physeal fracture of the distal radius that could not be classified according to the Salter-Harris system were identified from the hospital database. All radiographs were carefully examined and classified according to the existing classifications of Ogden and Peterson and a modified classification scheme. The results of the treatment were also evaluated. Results : Ninety-six physeal injuries could not be classified using the classification schemes of Ogden and Peterson. All injuries could be classified in five types using the new, modified nomenclature. Growth abnormalities of the distal radius were evaluated after an average follow-up time of 11 years. Growth arrest due to a physeal bar was detected only in one patient. Discussion : The proposed modified scheme is practical, incorporates all previous classification systems, allows classification of all physeal injuries of the distal radius that are not included in the Salter-Harris system and may assist comparison of treatment outcomes.

scholarly journals Effectiveness of Surgical versus Conservative Treatment for Distal Femoral Growth Plate Fractures: A Systematic Review

2019 ◽  
Vol 13 (1) ◽  
pp. 117-129
Author(s):  
Nicholas Hayes ◽  
Kandiah Umapathysivam ◽  
Bruce Foster
Keyword(s):  
Conservative Treatment ◽  
Growth Plate ◽  
Growth Arrest ◽  
High Rate ◽  
Angular Deformity ◽  
Leg Length ◽  
Subsequent Growth ◽  
Salter Harris ◽  
Rates Of Growth ◽  
Physeal Fractures

Background and Objective:The objective of this review was to determine whether surgery, in comparison to conservative treatment, is a safe and effective intervention for the management of distal femoral growth plate fractures.Methods:A systematic literature review was performed using a three-step search strategy. The PubMed, Embase and Scopus databases were utilized to identify current studies from 1 January 1990 to 8 January 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Primary outcomes of interest were rates of growth arrest and angular deformity.Results:Of the 7740 studies identified with the search, 15 case studies with data inclusive of outcomes of interest were selected for inclusion. A total of 466 patients were included.The rate of complication in the surgical population was 37.8%. In the conservative population the rate of complication was 34.0%. Five of the 15 papers showed Salter-Harris (SH) classification to correlate with prognosis, three papers showed the presence of displacement to correlate with prognosis which would have had an influence on the results of these higher graded injuries likely to have been managed operatively. A high rate of position loss and subsequent growth abnormalities was observed when conservative management was instituted.Conclusion:The rate of complication was marginally higher in the surgical population than that in the conservative population. This study also identified that higher severity distal femur physeal fractures, determined by the amount of displacement and Salter Harris grade, may associate a poorer outcome. It appears that managing higher severity distal femoral physeal injuries conservatively would be less likely to achieve and maintain reduction and therefore associate higher risks of malunion with subsequent growth arrest, leg length discrepancy and angular deformity as compared with surgical intervention. Further studies with higher patient numbers and comparable cohorts are needed to compare surgical and conservative interventions for the lower severity distal femoral physeal fractures.

scholarly journals What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

2017 ◽  
Vol 89 (1) ◽  
pp. 108-112 ◽  
Author(s):  
Hoon Park ◽  
Dong Hoon Lee ◽  
Seung Hwan Han ◽  
Sungmin Kim ◽  
Nam Kyu Eom ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Salter Harris ◽  
Physeal Fractures

Holding Power of Orthopaedic Screws in Bovine Femoral Heads

1993 ◽  
Vol 06 (03) ◽  
pp. 160-162 ◽  
Author(s):  
M. J. Ulm ◽  
D. G. Wilson
Keyword(s):  
Femoral Head ◽  
Cannulated Screws ◽  
Cancellous Screw ◽  
Holding Power ◽  
Cortical Screw ◽  
Femoral Heads ◽  
Cancellous Screws ◽  
Physeal Fractures

SummaryFemoral capital physeal fractures have been successfully repaired using 7.0 mm cannulated screws. The holding power of 7.0 mm cannulated screws was compared to the holding power of 5.5 mm cortical screws and 6.5 mm cancellous screws using paired bovine femoral heads. The 7.0 mm cannulated screw’s holding power was superior to the 6.5 mm cancellous screw and similar to that of the 5.5 mm cortical screw.When placed in the bovine femoral head, 7.0 mm cannulated screws have holding power greater than 6.5 mm cancellous screws and similar to 5.5 mm cortical screws.

Stabilization of a Physeal Fracture Using an Orthofix® Partially-threaded Kirschner Wire

1999 ◽  
Vol 12 (02) ◽  
pp. 88-91 ◽  
Author(s):  
D. D. Lewis ◽  
Susan M. Newell ◽  
O. I. Lanz
Keyword(s):  
Internal Fixation ◽  
Successful Treatment ◽  
Kirschner Wire ◽  
Clinical Results ◽  
Rigid Internal Fixation ◽  
Physeal Fracture ◽  
Type Iv ◽  
Salter Harris ◽  
Condylar Fractures

Successful treatment of humeral condylar fractures requires accurate reduction and rigid internal fixation which can be difficult to achieve in toy and/or miniature breed dogs. Stabilization of a Salter-Harris type IV physeal fracture of the numeral condyle was simplified by using Orthofix® partially-threaded Kirschner wire and provided excellent clinical results in a 1.5 kg miniature pinscher

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