Complications – Growth Disturbances
– growth arrest is particularly common in the distal femur – related to forces required to break it, and the morphology of the growth plate – with its undulating morphology, the damage is not uniform across the physeal cartilage. 83% of kids under 11 with a distal femoral physeal injury have a growth disturbance.
– the distal femur is the most common location of growth arrest, followed by distal tibia, proximal tibia, radius, humerus.
Bright classification of physeal arrest: I – peripheral, II – central, III – combined
– the peripheral arrests tend to cause angular deformity
– the central arrest tend to slow growth and show a tenting of the epiphyseal plate with cupping of the epiphysis by the metaphysis. Central arrest is more common with vascular injury, infection, or thermal injury. Peripheral arrest is more likely with fracture.
Certain injuries are typical: Salter III medial malleolus, Salter IV distal tibia, or any distal femur fracture
– important factors to consider: size of epiphyseal plate, rate of growth, growth remaining, and size of bar
– if bar is less than 50% of the growth plate, and there is two or more years of growth remaining, then resect.
– if not resectable, consider shutting down the rest of the physis
– always take into account what the anticipated growth will be if you leave the bar – both in terms of length and angulation. Then consider what will be the anticipated consequences of resecting it, or closing the physis.
– be prepared to follow for angular deformity which does not correct and requires osteotomy