Salter-Harris II Fractures of the Distal Femur: Does displacement, size of Thurston-Holland Fragment, or time to surgery affect treatment or risk of complication?

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.782-782
• Main Authors: Nguyen, Ivy, Ellis, Henry B., Wilson, Philip L., Ho, Christine Ann
• Format: Article
• Language: English
• Subjects: All terrain vehicles; Bone implants; Demographics; Femur; Fractures; Fragments; Injuries; Lawnmowers; Patients; Pediatrics; Risk factors; Surgery; Trauma
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA8.782

Purpose: Despite recognition that physeal fractures of the distal femur have a high risk of growth arrest, specific factors contributory to this risk are poorly understood. The purpose of this study is to evaluate fracture characteristics that may affect treatment or outcome of Salter-Harris type II (SH-II) fractures. Method: A retrospective review of 53 patients diagnosed with SH-II fracture, under the age of 19, was performed. Subjects were identified via ICD-9 and ICD-10 codes and attending operative notes at a single level-1 trauma center between 2004-17. Demographic, radiographic, and treatment data were collected. Mann-Whitney test was used to compare means between groups. Results: Of the 53 subjects, 68% were male and 32% female, with a mean age of 11.7 years (range: 0.9-17.7 years). High energy mechanisms (motor vehicle involvement, sports, ATV, lawnmower) were responsible for the majority of injuries (60%). All patients had surgical fixation of their fractures (Figure 1); 51% received Thurston-Holland (TH) screw fixation, 26% retrograde Kirschner wire cross-pinning, and 17% anterograde cross-pinning. Fractures treated with only screw fixation of TH fragments had fragments 14.7 mm larger in height (P = 0.001) and 9.6 mm larger in width (P = 0.001) on average than fractures fixed by wire cross-pinning. TH fragments greater than 3 cm in height and width were fixed with cannulated screws in 85% of cases. TH fragments less than 3 cm in either dimension were more commonly treated with wire fixation (59% vs. 35%). Six patients (33%) out of 18 who had open physes at injury developed complication due to physeal arrest; two requiring further surgical intervention. Leg-length discrepancy ranged from 0.5-1.5 cm, and two patients also developed valgus deformities greater than 10°. Timing of presentation or time from injury to reduction was not associated with a complication (p=0.3733 and p=0.2415, respectively). Higher mechanism of injury, associated injuries, or greater fracture displacement was not a risk factor for physeal arrest or complication in this cohort (Table 1). Conclusion: Fractures with Thurston-Holland fragment size greater than 3 cm were more likely to undergo screw fixation, and fractures with smaller fragments were cross-pinned. Timing of treatment, displacement, and mechanism were not associated with physeal arrest.