Experimental physeal fracture-separations treated with rigid internal fixation

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Skeletal Biology

Background:

• Salter-Harris Type-III and Type-IV fractures involve the physis and articular surface.
• These injuries in growing bones can lead to significant deformities and growth disturbances.
• Current treatment strategies aim to restore anatomical alignment and preserve physeal integrity.

Purpose of the Study:

• To evaluate the healing process of Salter-Harris Type-III and Type-IV distal femur fractures in a rabbit model.
• To compare the outcomes of untreated injuries with those treated by anatomical reduction and rigid internal fixation.
• To assess the impact of surgical intervention on physeal healing and subsequent bone deformity.

Main Methods:

• Salter-Harris Type-III and Type-IV epiphyseal injuries were surgically created in the distal femur of growing rabbits.
• One group received no treatment, while another underwent anatomical reduction and internal fixation with a cortical screw.
• A control group underwent a sham operation on the contralateral knee.

Main Results:

• Untreated Type-III injuries resulted in progressive angular deformity of the femur.
• Untreated Type-IV injuries led to an increasing step-off on the articular surface.
• Treated fractures showed healing without osseous callus formation and no significant physeal abnormalities.

Conclusions:

• Anatomical reduction and rigid internal fixation effectively prevent deformities associated with Salter-Harris Type-III and Type-IV distal femur fractures.
• This surgical approach promotes normal physeal healing, avoiding the development of osseous bridges and subsequent growth disturbances.
• Rigid fixation is crucial for achieving favorable outcomes in these complex physeal injuries.