Management of Salter-Harris II distal femur fractures - what is the state of practice? A survey of Pediatric Orthopaedic Society of North America membership.

Appropriate treatment of Salter-Harris (SH) II distal femoral physeal fractures is crucial due to risks of growth arrest and angular deformity. Low incidence renders sufficiently powered, prospective research difficult. This study aimed to assess the current state of management of these fractures on the basis of the Pediatric Orthopaedic Society of North America (POSNA) membership experience. POSNA members were surveyed via an emailed REDCAP survey. Questions included respondent demographics, experience, practice environment and clinical questions regarding preferred treatment and postoperative management based, in part, on an illustrative case of a nighttime presentation of a displaced SH-II distal femur fracture. Descriptive statistics were performed to summarize the preferred management among POSNA members. Twenty-eight percent (376/1344) of contacted POSNA members responded to the survey meeting sample size criteria of membership representation. Respondents' median years in practice were 17 (IQR 7-27). Surgical management of the presented case was preferred by most (96.3%) respondents. If no vascular compromise was present (ABI >0.9), most (86.6%) felt it was appropriate to wait for intervention on the following day. One-third (32.7%) of respondents considered every SH-II as an indication for surgical treatment. Screw fixation is the most common implant selection for operatively managed injuries, with the majority choosing not to electively remove screws. Those who opted for pin fixation tended to remove pins by 3-4 weeks postoperatively. For immediate postoperative immobilization, long leg casting (44.4%) was selected more commonly than splinting or knee immobilizers. Nearly all (99.7%) respondents preferred follow-up until skeletal maturity. In cases of suspected growth arrest, 76% felt MRI was necessary for further evaluation. Operative management of SH-II distal femur fractures is preferred among POSNA members, particularly in cases of displaced fractures or when closed reduction had failed. Except for immediate postoperative immobilization preferences, pediatric orthopedic surgeons appear to have a majority consensus regarding treatment practices, postoperative management and indications and timing of hardware removal. Level of evidence Level V Expert Opinion.