Epidemiology and risk factors for premature physeal closure in distal femur fractures
DOI:
https://doi.org/10.2340/17453674.2023.13654Keywords:
Children, Distal femur, Epidemiology, Femur, Growth arrest, Incidence, Knee, Orthopaedics, Paediatric orthopaedics, Premature physeal closure, Risk factorsAbstract
Background and purpose: Premature physeal closure (PPC) is a common and concerning complication to distal femoral fractures as the distal growth plate accounts for 70% of the growth of the femur. The literature is not unanimous in determining the risk factors of PPC, and the epidemiological characterization of these fractures is limited. Our aim was to calculate the population-based incidence and investigate risk factors for PPC in these fractures.
Patients and methods: In this register-based study, between 2014 and 2021, 70 children with distal femoral physeal fractures presented to our hospital. Demographic data, and fracture- and treatment-related details were collected using the Kids’ Fracture Tool. A directed acyclic graph (DAG) was constructed to determine confounding factors used in the risk analysis.
Results: Physeal fractures of the distal femur occurred with an annual incidence of 6/105 children, and a resulting PPC occurred in 16/70 (23%) with an annual incidence of 1.3/105 children. In multivariable analysis, dislocation exceeding 10 mm was a risk factor for PPC (OR 6.3, CI 1.4-22).
Conclusion: One-fourth of distal femoral physeal fractures developed PPC. Greater dislocation and higher injury energy were significant risk factors, whereas choice of fracture treatment was not an independent risk factor. All patients with PPC belonged in the age group 11–16 years.
Downloads
References
Peterson H A, Madhok R, Benson J T, Ilstrup D M, Melton L J 3rd. Physeal fractures, Part 1: Epidemiology in Olmsted County, Minnesota, 1979–1988. J Pediatr Orthop 1994; 14: 423-30. doi: 10.1097/01241398-199407000-00002. DOI: https://doi.org/10.1097/01241398-199407000-00002
Kawamoto K, Kim W C, Tsuchida Y, Tsuji Y, Fujioka M, Horii M, et al. Incidence of physeal injuries in Japanese children. J Pediatr Orthop B 2006; 15: 126-30. doi: 10.1097/01.bpb.0000191874.69258.0b. DOI: https://doi.org/10.1097/01.bpb.0000191874.69258.0b
Mizuta T, Benson W M, Foster B K, Paterson D C, Morris L L. Statistical analysis of the incidence of physeal injuries. J Pediatr Orthop 1987; 7: 518523. doi: 10.1097/01241398-198709000-00003. DOI: https://doi.org/10.1097/01241398-198709000-00003
Arkader A, Warner W C Jr, Horn B D, Shaw R N, Wells L. Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop 2007; 27: 703-8. doi: 10.1097/BPO.0b013e3180dca0e5. DOI: https://doi.org/10.1097/BPO.0b013e3180dca0e5
Adams A J, Mahmoud M A H, Wells L, Flynn J M, Arkader A. Physeal fractures of the distal femur: does a lower threshold for surgery lead to better outcomes? J Pediatr Orthop B 2020; 29: 40-6. doi: 10.1097/BPB.0000000000000664. DOI: https://doi.org/10.1097/BPB.0000000000000664
Eid A M, Hafez M A. Traumatic injuries of the distal femoral physis: retrospective study on 151 cases. Injury 2002; 33: 251-5. doi: 10.1016/s0020-1383(01)00109-7. DOI: https://doi.org/10.1016/S0020-1383(01)00109-7
Bellamy J T, Ward L A, Fletcher N D. Evaluation of pediatric distal femoral physeal fractures and the factors impacting poor outcome requiring further corrective surgery. J Pediatr Orthop B 2021; 30: 6-12. doi: 10.1097/BPB.0000000000000733. DOI: https://doi.org/10.1097/BPB.0000000000000733
Garrett B R, Hoffman E B, Carrara H. The effect of percutaneous pin fixation in the treatment of distal femoral physeal fractures. J Bone Joint Surg Br 2011; 93: 689-94. doi: 10.1302/0301-620X.93B5.25422. DOI: https://doi.org/10.1302/0301-620X.93B5.25422
Riseborough E J, Barrett I R, Shapiro F. Growth disturbances following distal femoral physeal fracture-separations. J Bone Joint Surg Am 1983; 65: 885-93. PMID: 6885868. DOI: https://doi.org/10.2106/00004623-198365070-00002
Ilharreborde B, Raquillet C, Morel E, Fitoussi F, Bensahel H, Pennecot G F, et al. Long-term prognosis of Salter-Harris type 2 injuries of the distal femoral physis. J Pediatr Orthop B 2006; 15: 433-8. doi: 10.1097/01.bpb.0000228384.01690.aa. DOI: https://doi.org/10.1097/01.bpb.0000228384.01690.aa
Thomson J D, Stricker S J, Williams M M. Fractures of the distal femoral epiphyseal plate. J Pediatr Orthop 1995; 15: 474-8. doi: 10.1097/01241398-199507000-00013. DOI: https://doi.org/10.1097/01241398-199507000-00013
Lombardo S J, Harvey J P Jr. Fractures of the distal femoral epiphyses: factors influencing prognosis: a review of thirty-four cases. J Bone Joint Surg Am 1977; 59: 742-51. PMID: 908697 DOI: https://doi.org/10.2106/00004623-197759060-00005
Peterson H A. Physeal fractures, Part 3: Classification. J Pediatr Orthop 1994; 14: 439-48. doi: 10.1097/01241398-199407000-00004. DOI: https://doi.org/10.1097/01241398-199407000-00004
Laaksonen T, Kosola J, Nietosvaara N, Puhakka J, Nietosvaara Y, Stenroos A. Epidemiology, treatment, and treatment quality of over-riding distal metaphyseal radial fractures in children and adolescents. J Bone Joint Surg Am 2022; 104: 207-14. doi: 10.2106/JBJS.21.00850. DOI: https://doi.org/10.2106/JBJS.21.00850
City of Helsinki Executive Office, Urban Research and Statistics. Statistical Yearbook of Helsinki 2019. (Accessed 2021 Oct 12.) Available from: https://www.hel.fi/hel2/tietokeskus/julkaisut/pdf/20_03_10_Vuosikirjaenglanti2019.pdf [Context Link].2014-2021.
Shrier I, Platt R W. Reducing bias through directed acyclic graphs. BMC Med Res Methodol 2008; 8: 70. doi: 10.1186/1471-2288-8-70. DOI: https://doi.org/10.1186/1471-2288-8-70
Rockwood C A, Beaty J H, Kasser J R. Rockwood and Wilkins’ fractures in children. 7th ed. Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins; 2010.
Pritchett J W. Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res 1992; (275): 274-9. PMID: 1735225. DOI: https://doi.org/10.1097/00003086-199202000-00041
Frost M W, Rahbek O, Iobst C, Bafor A, Duncan M, Kold S. Complications and risk factors of intramedullary bone lengthening nails: a retrospective multicenter cohort study of 314 FITBONE and PRECICE nails. Acta Orthop 2023; 94: 51-9. doi: 10.2340/17453674.2023.8479. DOI: https://doi.org/10.2340/17453674.2023.8479
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Sini-Tuuli Koivisto, Topi Laaksonen, Ilkka Helenius, Henri Vasara, Antti Stenroos
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
