Table 1: Key intervention characteristics of included studies (comparative studies of surgical and conservative interventions).

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
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)

Patient characteristics for each study are presented in Table 1. Abbreviations: † Based on descriptive studies only. Conservative management preferentially used in lower SH Injuries, potentially influencing the results. CR, Closed Reduction; ORIF, Open Reduction Internal Fixation; LLD, Leg Length Discrepancy; ROM (Knee) Range Of Motion; K wire, Kirschner wire; AO screws, Arbeitsgemeinschaft für Osteosynthesefragen screws.

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