Journal of Pediatric Orthopaedics - 2026-03-03 - Journal Article
A Retrospective Analysis of the Correlation Between Periosteal Entrapment and Growth Disturbances in Salter-Harris II Physeal Fractures of the Distal Tibia in Children.
Zhang H, Yang M, Tong X, Wang X, Dong J, Gong H, Wang B
Topics
Key Takeaway
Periosteal entrapment was not an independent risk factor for growth disturbances in distal tibial Salter-Harris II fractures, with an overall growth disturbance incidence of 14.8% across 27 patients regardless of treatment method.
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Summary
This study examined whether periosteal entrapment independently predicts growth disturbances in distal tibial Salter-Harris II fractures across three treatment groups (conservative, CR-PF, ORIF). Univariable and multivariable regression identified no independent risk factors for growth disturbances, and the 14.8% overall incidence did not differ significantly between treatment groups (P>0.05). All patients achieved 100% excellent AOFAS scores at 6 months; the sole case of premature physeal closure occurred in the ORIF group at Kump's bump, resulting in ankle valgus.
Key Limitation
The sample size of 27 patients is insufficient to power regression analysis for a 14.8% event rate, making the null finding statistically inconclusive rather than definitively exonerating periosteal entrapment as a risk factor.
Original Abstract
BACKGROUND
Periosteal entrapment (PE) in displaced distal tibial Salter-Harris (S-H) II fractures is considered a risk for growth disturbances, but causality is debated.
QUESTIONS/PURPOSES
To investigate whether PE is an independent risk factor for growth disturbances in distal tibial S-H II physeal fractures and to compare the clinical efficacy of different treatment methods.
PATIENTS AND METHODS
Retrospective analysis of 27 patients (2015 to 2024) with distal tibial S-H II fractures and confirmed PE [magnetic resonance imaging (MRI): n=21; follow-up radiograph: n=6]. Patients received conservative treatment, closed reduction and percutaneous fixation (CR-PF), or open reduction internal fixation (ORIF). Functional outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire. Correlations (phi coefficient) and risk factors (univariable/multivariable regression) were assessed between PE and growth disturbances.
RESULTS
Patients (19 boys and 8 girls; mean age 9.99 y or younger) were followed for a mean of 22.13 months. Overall incidence of growth disturbances was 14.8%, and the difference in the proportion of growth disturbances among the 3 groups was not significant (P>0.05). No independent risk factors were identified in univariable or multivariable analysis (all P>0.05). All fractures healed, and all groups showed an excellent AOFAS score (100%) at 6 months postinjury and comparable functional recovery (all P>0.05). The only case of premature physeal closure (PPC) occurred in the ORIF group, with the bony bridge appearing at the distal tibial Kump's bump, subsequently leading to an ankle valgus deformity.
CONCLUSION
PE is not independently correlated with growth disturbances following distal tibia SH II fractures, challenging the traditional mainstream view of its causal role in causing growth disturbances. In addition, the therapeutic effects of different treatment methods are comparable. Conservative treatment should be preferred when closed reduction achieves good alignment, and routine periosteal stripping may be unnecessary.
LEVEL OF EVIDENCE
Level III.