2015 ISAKOS Biennial Congress Paper #0

Growth Disturbance after Surgical Treatment of Pediatric Tibial Spine Fracture: Results from a Multicenter Cohort

Aristides Ignacio Cruz, MD, East Providence, RI UNITED STATES
Ryan O'Donnell, MD, Providence, RI UNITED STATES
Nicholas Lemme, MD, Rumford, RI UNITED STATES
Lauren Piana, MD, Providence, RI UNITED STATES
Theodore Ganley, MD, Philadelphia, PA UNITED STATES
Peter D. Fabricant, MD, MPH, New York, NY UNITED STATES
Daniel W. Green, MD, MS, New York, NY UNITED STATES
Scott McKay, MD, Houston, TX UNITED STATES
Gregory A. Schmale, MD, Seattle, WA UNITED STATES
R. Justin Mistovich, MD, MBA, Cleveland, Ohio UNITED STATES
Soroush Baghdadi, MD, Philadelphia, PA UNITED STATES
Henry B. Ellis, MD, Dallas, TX UNITED STATES
Brown University, Providence, RI, UNITED STATES

FDA Status Not Applicable

Summary: This study describes the incidence of growth disturbance after surgical treatment of pediatric tibial spine avulsion fractures.

Abstract:

Background

Tibial spine fractures (TSF) are a relatively uncommon injury of the knee seen predominantly in the skeletally immature pediatric population, and often require surgical treatment. We sought to assess if surgical treatment of these fractures carry a risk of growth disturbance and investigate risk factors that may contribute to a growth disturbance.

Methods

A retrospective analysis of children undergoing treatment of tibial spine fractures was performed, drawing from a multicenter cohort among 10 tertiary care children’s hospitals. The entire cohort of surgically treated TSFs was analyzed for incidence and risk factors of growth disturbance. The cohort was stratified into those that were under the age of 13 years at the time of treatment in order to evaluate the risk of growth disturbance in those with significant substantial growth remaining. Patients with growth disturbance in this cohort were further analyzed based on age, sex, surgical repair technique, implant type, and preoperative radiographic measurements with chi-square, t-tests and multivariate logistic regression.

Results

661 patients were reviewed and 645 patients were available for analysis after exclusions. 9 patients (1.4%) were found to have growth disturbance. Eight out of nine patients with growth disturbance were found to have an overgrowth of the operative extremity (mean 1.075 cm, range 0.5 – 2cm). The other patient was found to have a valgus angular deformity which required a guided growth procedure. Patients that developed growth dDisturbance were younger than those without (9.7 years vs. 11.9 years, p = 0.019). Four out of nine patients that experienced growth disturbance had valgus mechanical axes prior to injury. In the cohort of patients under the age of 13 years, 9 out of 404 (2.2%) experienced growth disturbance. There was no association with demographic factors, fracture characteristics, surgical technique, hardware type, or anatomic placement (i.e., transphyseal vs. physeal sparing fixation) and growth disturbance.

Conclusions

The risk of growth disturbance after tibial spine fracture surgery is low, with a higher risk in patients who are younger at the time of injury. In those with growth disturbance, growth acceleration of the affected limb is common. Although there is no association with surgical technique, practitioners should be aware of this potential complication when treating tibial spine fractures.