Oklahoma State University Medical Center, Oklahoma State University College of Osteopathic Medicine, Tulsa, OK 45229-3039, USA.
J Orthop Trauma. 2009 Oct;23(9):663-7. doi: 10.1097/BOT.0b013e3181a4f25b.
Growth disturbance of the distal femur is the most common complication after distal femoral growth plate fracture. The purpose of our study was to pool data from the literature to determine the incidence of growth disturbance in relation to the Salter-Harris (SH) classification. Additionally, we evaluated the potential influence of fracture displacement and treatment method.
A structured PubMed search was performed to identify all reports on distal femoral growth plate fractures published in the English language literature, from 1950 to 2007. Reference lists from identified articles and bibliographies from standard pediatric fracture texts were also scrutinized. For a study to be included in this review, it needed to have at least 10 patients with a minimum of 1 year follow-up and be published in the English language. A total of 16 articles met the criteria for inclusion, which accounted for 564 fractures.
Of the 564 fractures, 291 (52%) had a growth disturbance. Growth disturbance occurred in 36% of SH 1 fractures, 58% in SH 2, 49% in SH 3, and 64% in SH 4 fractures. In studies with patient-level data, there was growth disturbance in 65% of fractures with displacement and 31% of the fractures with no displacement had growth disturbance. The odds of a displaced fracture having growth arrest was 4 times greater than that of a nondisplaced fracture having a growth arrest. (P = 0.0015) In the studies with patient-level data, 58% (70/121) of fractures treated without fixation developed a growth disturbance, with 37% (45/121) being a clinically significant disturbance. Of the patients treated with fixation, including those who were initially treated without but lost reduction, 63% (19/30) developed a growth disturbance, with 27% (8/30) being clinically significant. Significant growth disturbance was defined as a leg length discrepancy equal to or greater than 1.5 cm and/or 5 degrees of varus or valgus deformity. SH 4 fractures had the greatest incidence of developing a leg length discrepancy greater than 1.5 cm (9/37). Twenty-two percent (112/506) of all distal femoral growth plate fractures developed a leg length discrepancy of greater than 1.5 cm.
Fifty-two percent of distal femoral growth plate fractures had some form of growth disturbance. Twenty-two percent (112/506) of all distal femoral growth plate fractures developed a leg length discrepancy of greater than 1.5 cm. SH 1 fractures had the lowest incidence of growth disturbance (36%), whereas SH 4 fractures had the highest rate of growth disturbance at 64%. Although there is a greater incidence of growth disturbance in patients who were treated with fixation (58% versus 63%), there was a decreased incidence of significant growth disturbance (37% versus 27%).
股骨远端骺板生长障碍是股骨远端骺板生长板骨折后最常见的并发症。本研究的目的是汇集文献中的数据，以确定与 Salter-Harris（SH）分类相关的生长障碍发生率。此外，我们还评估了骨折移位和治疗方法的潜在影响。
通过结构合理的 PubMed 搜索，确定了从 1950 年到 2007 年发表在英文文献中的所有关于股骨远端骺板骨折的报告。还仔细检查了确定文章的参考文献列表和标准儿科骨折教科书的参考书目。为了将研究纳入本综述，研究需要至少有 10 名患者，且随访时间至少为 1 年，并以英文发表。共有 16 篇文章符合纳入标准，共涉及 564 例骨折。
在 564 例骨折中，有 291 例（52%）发生了生长障碍。SH 1 骨折中生长障碍发生率为 36%，SH 2 骨折为 58%，SH 3 骨折为 49%，SH 4 骨折为 64%。在有患者水平数据的研究中，有移位的骨折中有 65%发生生长障碍，无移位的骨折中有 31%发生生长障碍。有移位骨折发生生长停滞的可能性是无移位骨折的 4 倍。（P = 0.0015）在有患者水平数据的研究中，未经固定治疗的 58%（70/121）骨折发生生长障碍，其中 37%（45/121）为临床显著障碍。接受固定治疗的患者中，包括最初未经固定治疗但失去复位的患者，有 63%（19/30）发生生长障碍，其中 27%（8/30）为临床显著障碍。显著生长障碍定义为下肢长度差异等于或大于 1.5 厘米和/或 5 度内翻或外翻畸形。SH 4 骨折发生大于 1.5 厘米的下肢长度差异的发生率最高（9/37）。所有股骨远端骺板骨折中有 22%（112/506）发生大于 1.5 厘米的下肢长度差异。
52%的股骨远端骺板骨折存在某种形式的生长障碍。所有股骨远端骺板骨折中有 22%（112/506）发生大于 1.5 厘米的下肢长度差异。SH 1 骨折生长障碍发生率最低（36%），而 SH 4 骨折生长障碍发生率最高（64%）。虽然接受固定治疗的患者生长障碍发生率较高（58%比 63%），但严重生长障碍发生率较低（37%比 27%）。
