Study | Surgical Interventions | Conservative Interventions | Outcomes Reported | Based on Reported Outcomes, was Surgical Management Associated with Better/Worse Outcomes†? |
---|---|---|---|---|
Arkader A., Warner W., Horn, D., Shaw R., Wells L., 2007 [6, 19] | Closed reduction (CR) with percutaneous crossed Steinman pins Annulated screws Multiple pin fixation External fixation |
Long leg cast +/- pelvic band Posterior splint Cylinder cast |
Complications: Growth arrest, LLD, angular deformity, need for surgical correction, loss of reduction, superficial Steinman pin infection | Worse |
Ilharreborde B., Raquillet C., Morel E., Fitoussi F., Bensahel H., Penneçot G., Mazda K., 2006 [23] | ORIF of the metaphyseal fragment by cortical screws Debridement for open fracture followed by open reduction and osteosyntheis |
Plaster cast immobilization only CR + plaster cast |
LLD, Angular deformity, limitation in ROM, epiphysiodesis, ligamentous laxity | Worse |
Plánka L., Skvaril J., Stary D., Jochymek J., Gál P., 2008 [21] | Repositioning, transfixion by K wires or 1-2 cannulated tension screws. | Spica cast | Angulation, shortening, development of porosis, limitation in hip and knee ROM, re-dislocation, re-surgery, damage to neurovascular plexus, complete healing of epiphysiolysis | Worse |
Eid A., Hafez M., 2002 [4] | ORIF with 2 K wires or cancellous screws which do not cross the physis | Immobilised in long leg cast CR + long leg cast CR + hip spica |
Subjective complaints, gait, lower limb deformity, range of movements in the knee, ligamentous laxity, thigh atrophy, limb length discrepancy clinically, angular deformity clinically, premature growth arrest or angular deformities on XR, limb length discrepancy on XR | Worse* |
Garrett B., Hoffman E., Carrara H., 2011 [13] | CR + internal fixation with 2 smooth percutaneous K wires or Steinmann pins (1.8 to 3.2mm) crossing the physis ORIF with above K wires/ pins or screws |
Cast only Closed reduction |
Physeal bar formation | Worse (trend only) |
Buess-Watson E., Exner G., Illo O., 1994 [24] | Open Reduction Internal Fixation (ORIF) CR + percutaneous pinning |
Cast immobilization CR + cast immobilization |
Asymmetric growth arrest/axis deviation, LLD, (re)operation, stability | Worse for secondary operations only |
Caterini R., Farsetti P., d’Arrigo C., Ippolito E., 1991 [22] | ORIF with K wire + hip spica cast | None (no treatment) Bilateral hip spica cast for 8 weeks Hip spica cast |
Symptoms, physical examination findings, XR examination of complications | [Sample size too small for comparison. 1/7 patients surgically managed] |
Lippert W., Owens R., Wall E., 2010 [25] | Closed reduction percutaneous pinning ORIF |
Cast Knee immobilizer |
LLD/ growth disturbance, ROM deficit, pain, physical limitations | No difference reported/ detected |
Edmunds I., Nade S., 1993 [3] | Closed reduction and percutaneous fixation with wires or screws Closed reduction and traction Open reduction and internal fixation (fixation with K wires, AO screws, Herbert screws) |
Robert Jones bandage only Plaster of Paris only Closed reduction and Robert Jones Closed reduction and cast |
LLD, angular deformity, limitation in ROM, osteomyelitis, lost position, further treatment required | Better |
Thomson J., Stricker S., Williams M., 1995 [12] | Reduction, internal fixation with screw or pin | CR in Emergency Room or theatre | LLD, malalignment, loss of ROM, loss of reduction, further bony surgery | Better (trend only) |