Maria Tirta, Søren Kold, Ali Yalcinkaya, Jan Duedal Rölfing, Ole Rahbek
{"title":"Does rigid intramedullary nailing through open growth plates cause harm? A scoping review.","authors":"Maria Tirta, Søren Kold, Ali Yalcinkaya, Jan Duedal Rölfing, Ole Rahbek","doi":"10.1530/EOR-2024-0189","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This scoping review aimed to map the literature on the effects of growth plate violation with intramedullary locking nail (IMN) at the knee in skeletally immature patients. It focused on assessing clinical and experimental outcomes, with particular attention to complications such as growth arrest and deformities.</p><p><strong>Methods: </strong>This scoping review followed the PRISMA extension for scoping reviews, with registered protocol at the Open Science Framework. A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus was performed for studies involving pediatric patients with open growth plates treated with IMNs at the knee and animal studies assessing physeal violations.</p><p><strong>Results: </strong>Ten studies were included, comprising six clinical, three animal studies, and one review. The clinical studies included 89 pediatric patients treated either with retrograde femoral or antegrade tibial nailing. The youngest patient was a 7-years-old female, and there were no reported cases of growth arrest following IMN. Animal studies demonstrated that up to 7% of physeal violation did not result in significant growth disturbances, but exceeding this threshold led to growth inhibition. In addition, implant removal showed mixed results, with early bone bridge formation noted in few cases.</p><p><strong>Conclusions: </strong>Limited physeal violations by IMN may not cause significant growth disturbances, while exceeding certain thresholds could result in adverse outcomes. The current evidence is insufficient to make recommendations on the use of IMN at the knee in skeletally immature patients, particularly to make recommendations regarding age, femur/tibia and sex. Further research is needed to establish long-term outcomes and optimal guidelines for safe physeal instrumentation.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"487-495"},"PeriodicalIF":4.0000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Efort Open Reviews","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1530/EOR-2024-0189","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: This scoping review aimed to map the literature on the effects of growth plate violation with intramedullary locking nail (IMN) at the knee in skeletally immature patients. It focused on assessing clinical and experimental outcomes, with particular attention to complications such as growth arrest and deformities.
Methods: This scoping review followed the PRISMA extension for scoping reviews, with registered protocol at the Open Science Framework. A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus was performed for studies involving pediatric patients with open growth plates treated with IMNs at the knee and animal studies assessing physeal violations.
Results: Ten studies were included, comprising six clinical, three animal studies, and one review. The clinical studies included 89 pediatric patients treated either with retrograde femoral or antegrade tibial nailing. The youngest patient was a 7-years-old female, and there were no reported cases of growth arrest following IMN. Animal studies demonstrated that up to 7% of physeal violation did not result in significant growth disturbances, but exceeding this threshold led to growth inhibition. In addition, implant removal showed mixed results, with early bone bridge formation noted in few cases.
Conclusions: Limited physeal violations by IMN may not cause significant growth disturbances, while exceeding certain thresholds could result in adverse outcomes. The current evidence is insufficient to make recommendations on the use of IMN at the knee in skeletally immature patients, particularly to make recommendations regarding age, femur/tibia and sex. Further research is needed to establish long-term outcomes and optimal guidelines for safe physeal instrumentation.
目的:本综述旨在对骨未成熟患者膝关节髓内锁定钉(IMN)破坏生长板影响的文献进行梳理。它侧重于评估临床和实验结果,特别关注生长停滞和畸形等并发症。方法:该范围综述遵循PRISMA范围综述扩展,并在开放科学框架注册。我们对PubMed、Embase、Cochrane Library、Web of Science和Scopus进行了全面的检索,包括在膝关节处使用IMNs治疗开放生长板的儿科患者的研究和评估生理侵犯的动物研究。结果:纳入10项研究,包括6项临床研究、3项动物研究和1项综述。临床研究包括89例接受逆行股骨或顺行胫骨内钉治疗的儿童患者。最年轻的患者是一名7岁的女性,没有报告IMN后生长停止的病例。动物研究表明,高达7%的物理违反不会导致显著的生长障碍,但超过这个阈值会导致生长抑制。此外,种植体移除的结果好坏参半,在少数病例中发现早期骨桥形成。结论:IMN有限的生理侵犯可能不会引起明显的生长障碍,而超过一定的阈值可能导致不良后果。目前的证据不足以对骨骼不成熟的患者在膝关节处使用IMN提出建议,特别是对年龄、股骨/胫骨和性别提出建议。需要进一步的研究来建立长期结果和安全物理仪器的最佳指南。证据等级:4。
期刊介绍:
EFORT Open Reviews publishes high-quality instructional review articles across the whole field of orthopaedics and traumatology. Commissioned, peer-reviewed articles from international experts summarize current knowledge and practice in orthopaedics, with the aim of providing systematic coverage of the field. All articles undergo rigorous scientific editing to ensure the highest standards of accuracy and clarity.
This continuously published online journal is fully open access and will provide integrated CME. It is an authoritative resource for educating trainees and supports practising orthopaedic surgeons in keeping informed about the latest clinical and scientific advances.
One print issue containing a selection of papers from the journal will be published each year to coincide with the EFORT Annual Congress.
EFORT Open Reviews is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with The British Editorial Society of Bone & Joint Surgery.