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Does rigid intramedullary nailing through open growth plates cause harm? A scoping review
Insights
Intramedullary locking nails (IMNs) may cause limited growth disturbances in pediatric knee injuries. However, exceeding physeal violation thresholds can lead to adverse outcomes, necessitating further research for safe guidelines.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomedical Engineering
Background:
- Growth plate injuries in skeletally immature patients require careful management to prevent long-term deformities.
- Intramedullary locking nails (IMNs) are used for fracture fixation, but their impact on open growth plates, particularly at the knee, is not fully understood.
Purpose of the Study:
- To map the existing literature on the effects of growth plate violation using IMNs at the knee in pediatric patients.
- To assess clinical and experimental outcomes, focusing on complications like growth arrest and deformities.
Main Methods:
- A scoping review following PRISMA extension guidelines was conducted.
- Searches were performed across major databases (PubMed, Embase, Cochrane, Web of Science, Scopus) for relevant clinical and animal studies.
- Inclusion criteria focused on pediatric patients with open growth plates treated with IMNs at the knee and animal models of physeal violation.
Main Results:
- Ten studies (6 clinical, 3 animal, 1 review) were included, involving 89 pediatric patients.
- No growth arrest was reported in clinical cases; animal studies indicated <7% physeal violation was generally safe, but higher percentages caused growth inhibition.
- Implant removal showed mixed results, with some instances of early bone bridge formation.
Conclusions:
- Limited physeal violation with IMNs may not cause significant growth disturbances, but exceeding thresholds can lead to adverse effects.
- Current evidence is insufficient to provide recommendations on IMN use in skeletally immature patients at the knee.
- Further research is essential to determine long-term outcomes and establish guidelines for safe physeal instrumentation.
Purpose:
This scoping review aimed to map the literature on the effects of growth plate violation with intramedullary locking nail (IMN) at the knee in skeletally immature patients. It focused on assessing clinical and experimental outcomes, with particular attention to complications such as growth arrest and deformities.
Methods:
This scoping review followed the PRISMA extension for scoping reviews, with registered protocol at the Open Science Framework. A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus was performed for studies involving pediatric patients with open growth plates treated with IMNs at the knee and animal studies assessing physeal violations.
Results:
Ten studies were included, comprising six clinical, three animal studies, and one review. The clinical studies included 89 pediatric patients treated either with retrograde femoral or antegrade tibial nailing. The youngest patient was a 7-years-old female, and there were no reported cases of growth arrest following IMN. Animal studies demonstrated that up to 7% of physeal violation did not result in significant growth disturbances, but exceeding this threshold led to growth inhibition. In addition, implant removal showed mixed results, with early bone bridge formation noted in few cases.
Conclusions:
Limited physeal violations by IMN may not cause significant growth disturbances, while exceeding certain thresholds could result in adverse outcomes. The current evidence is insufficient to make recommendations on the use of IMN at the knee in skeletally immature patients, particularly to make recommendations regarding age, femur/tibia and sex. Further research is needed to establish long-term outcomes and optimal guidelines for safe physeal instrumentation.
Level Of Evidence:
4.
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