Risk factors for the development of premature physeal closure after a McFarland fracture in children.

IF 2.6 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2025-03-01 Epub Date: 2025-02-05 DOI:10.1007/s00264-025-06428-0

Yuancheng Pan, Yuchen Pan, Tianpeng Dai, Chentao Xue, Federico Canavese, Shunyou Chen

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Abstract

Purpose: In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC).

Methods: We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts.

Results: PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5 mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5 cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2 cm, and five patients with PPC complained of postoperative pain.

Conclusions: Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5 mm are at a higher risk for PPC.

Level of evidence: Observational study.

Level of evidence iii:

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儿童 McFarland 骨折后发生趾骨过早闭合的风险因素。

目的：1931年，McFarland报道了内踝骨骺骨折及其畸形，后来将其归类为Salter-Harris III型和IV型内踝骨折。围绕McFarland （MF）骨折儿童PPC风险增加因素的持续争议。本回顾性研究旨在探讨儿童MF骨折手术治疗的影像学和临床结果，并评估增加骨骺过早闭合（PPC）风险的潜在因素。方法：回顾性分析48例经手术治疗的MF骨折患儿。从图表中检索人口学数据，包括受伤时的年龄、性别、损伤机制、侧侧、初始移位、骨折类型、从受伤到手术的时间、复位方法、固定方法、取出硬体的时间以及患者是否发生PPC。结果：PPC发生率为35.4%（17/48）。我们的分析显示，有PPC的患者明显比没有PPC的患者年轻(P结论：年龄和初始移位是增加MF骨折儿童PPC风险的独立因素。具体而言，年龄在11.5岁以下的儿童和初始位移超过4.5毫米的儿童患PPC的风险更高。证据水平：观察性研究。证据等级iii：

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.