Article Title: Effectiveness of Surgical versus Conservative Treatment for Distal Femoral Growth Plate Fractures: A Systematic Review
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Article Link (see pdf below): https://openorthopaedicsjournal.com/VOLUME/13/PAGE/117/FULLTEXT/
The reason I chose this article is that during my pediatrics emergency department rotation, I encountered a 13-year-old male who presented with an acute right knee injury after a sports-related fall. He reported hearing an audible “pop,” had immediate pain, inability to bear weight, and limited knee flexion. On exam, there was no obvious deformity or neurovascular compromise, but imaging with X-ray and CT ultimately revealed a Salter-Harris type IV fracture of the proximal tibia. This case made me interested in reviewing the management of different Salter-Harris fractures, especially as Salter-Harris IV fractures are rare in pediatrics.
The article from The Open Orthopaedics Journal reviews growth-plate fractures of the distal femur and discusses outcomes associated with different treatment approaches. The authors conducted a systematic review of available literature and evaluated case series examining pediatric physeal fractures. Across the included studies, 466 pediatric patients with growth-plate fractures were evaluated, with most injuries occurring from high-energy mechanisms such as motor vehicle accidents, sports injuries, bicycle accidents, and other traumatic events. The majority of patients were adolescents and male, which is consistent with the higher participation in high-impact activities.
Salter-Harris fractures are classified from types I through V, with type II injuries being the most common and types III and IV representing intra-articular injuries that may carry a higher risk of complications. Management depends on fracture severity and displacement, with some patients treated conservatively with immobilization while others require surgical fixation to achieve proper alignment and prevent long-term complications.
The systematic review states that proximal tibial physeal fractures arerelatively rare but can have significant consequences if not treated appropriately, and surgical intervention is often required for Salter Harris fractures III and IV.
Overall, this article highlights the importance of prompt recognition and appropriate management of pediatric growth-plate injuries. My patient was ultimately transferred to Elmhurst Hospital for inpatient pediatric and orthopedic management.
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