O2064: Risk Factors for Growth Abnormality After Pediatric Tibial Spine Fracture in a Multicenter Cohort

Background:

Background: Tibial spine fractures (TSF) are a relatively uncommon injury of the knee seen predominantly in the skeletally immature pediatric population, and often require surgical treatment. We sought to assess if treatment of these fractures carry a risk of growth disturbance and investigate risk factors that may contribute to a growth abnormality.

Methods:

Methods: A retrospective analysis of children undergoing treatment of tibial spine fractures was performed, drawing from a multicenter cohort among 10 tertiary care children’s hospitals. The entire cohort of surgically treated TSFs was analyzed for incidence and risk factors of growth abnormality. The cohort was stratified into those that were under the age of 12 at the time of treatment in order to evaluate the risk of growth disturbance in those with significant growth remaining. Patients with growth abnormality in this cohort were further analyzed based on age, sex, surgical repair technique, implant type, and preoperative radiographic measurements.

Results:

Results: 659 patients were reviewed. 9 patients (1.4%) were found to have growth abnormalities. Eight out of nine patients with growth abnormality were found to have an overgrowth of the operative extremity (mean 1.075 cm, range 0.5 – 2cm). The other patient was found to have a valgus angular deformity which required a guided growth procedure. Patients that developed growth abnormality were younger than those without (9.7 years vs. 11.9 years.) Four out of nine patients that experienced growth abnormality had valgus mechanical axes prior to injury. In the cohort of patients under the age of 12 years, 8 out of 314 (2.5%) experienced growth disturbance. There was no association with demographic factors, fracture characteristics, surgical technique, hardware type, or anatomic placement (i.e. transphyseal vs. physeal sparing fixation) with growth disturbance.

Conclusion:

Conclusions: The risk of growth abnormality after tibial spine fracture surgery is low, with a higher risk in patients who are younger at the time of injury. In those with growth abnormality, growth acceleration of the affected limb is common. Although there is no association with surgical technique, practitioners should be aware of this potential complication when treating tibial spine fractures.