Pediatric Physeal Injury Management Techniques

Pediatric physeal injuries involve damage to the growth plate and can result in limb-length discrepancies, angular deformities or joint dysfunction if not managed appropriately. Techniques range from non-operative immobilisation and close monitoring of growth disturbances to advanced surgical interventions that preserve or restore physeal function. Central to modern management is accurate assessment of physeal status, using imaging modalities such as high-resolution MRI or functional bone SPECT/CT, and classification systems that guide treatment choice. Surgical approaches include open or closed reduction with internal fixation for displaced fractures, physeal bar resection to remove osseous bridges, and guided growth procedures (hemi-epiphysiodesis) to correct angular deviations over time. Integration of these strategies aims to balance immediate fracture stability with long-term growth potential, minimising complications such as premature physeal closure and deformity progression.

Research from Nature Portfolio

Recent studies have demonstrated that combining physeal bar resection with guided growth techniques significantly improves correction of angular deformities compared with bar resection alone. In a cohort of children treated for partial growth arrest of distal femoral, proximal tibial and distal tibial physes, those undergoing simultaneous temporary hemiepiphysiodesis showed greater angular correction and a lower rate of deformity worsening at follow-up. Detailed mapping of bar size via CT and systematic measurement of mechanical axis deviations confirmed that the dual approach promotes balanced physeal activity, leading to sustained limb-axis restoration without additional surgery. These findings support an algorithmic shift towards adjunctive guided growth in cases of focal physeal arrest.

Pediatric Physeal Injury Management Techniques publication trend

The graph below shows the total number of articles in pediatric physeal injury management techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Physeal bar resection: removal of osseous bridging across the growth plate to restore symmetrical physeal growth.

Hemi-epiphysiodesis (guided growth): temporary tethering of one side of the growth plate to modulate growth and correct angular deformities.

Salter-Harris classification: system categorising physeal fractures by involvement of physis, metaphysis and epiphysis.

SPECT/CT: hybrid imaging combining single-photon emission computed tomography with CT to assess functional activity and precise anatomy of the physis.

Angular deformity correction angle: measurement of change in limb-axis deviation pre- and post-intervention.

References

1. The efficacy of physeal bar resection with guided growth in the treatment of physeal arrest with angular limb deformity. Scientific Reports (2024).
2. Analysis of Physeal Fractures from the United States National Trauma Data Bank. Children (2022).
3. The effectiveness of physeal bar resection with or without Hemi-Epiphysiodesis to treat partial growth arrest. BMC Musculoskeletal Disorders (2023).
4. The role of 99mTc-DPD bone SPECT/CT in the management of growth disturbance of the long bones in pediatric patients: a retrospective observational study. BMC Musculoskeletal Disorders (2023).