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



Nicholas Hayes1, 2, *, Kandiah Umapathysivam1, Bruce Foster3
1 The Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia
2 Department of Orthopaedic Surgery, Redcliffe Hospital, Brisbane, Queensland, Australia
3 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia

Abstract

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.

Keywords: Distal femur, Growth plate, Physeal injuries, Management, Surgery, Outcomes.


Abstract Information


Identifiers and Pagination:

Year: 2019
Volume: 13
Publisher Item Identifier: EA-TOORTHJ-2018-92

Article History:

Received Date: 22/12/2018
Revision Received Date: 26/02/2019
Acceptance Date: 28/02/2019
Electronic publication date: 07/03/2019
Collection year: 2019

© 2019 Hayes et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Correspondence: Address correspondence to this author at 217 Fullarton Road, Eastwood, South Australia 5063; Fax: (08) 83733153; Tel: (08) 83733155; E-mail: nicholas.hayes5@gmail.com