Pediatric physeal fractures and growth disturbance: current concepts and surgical approaches

Physeal fractures account for a significant percentage of pediatric fractures and carry a unique risk of resultant limb deformity due to their potential to disrupt normal bone growth. While most of these fractures heal without consequence, up to 10% result in growth disturbances that can cause limb length discrepancy or angular deformity. Surgical strategies for managing these deformities include physeal bar excision, epiphysiodesis, and corrective osteotomies. These interventions aim to restore limb alignment and preserve function. In this review, we provide an overview of the growth plate physiology, classification systems for physeal fractures, and the spectrum of complications that may arise following growth plate injury. We also present an overview of surgical strategies and demonstrate their applications through several case examples.