Economic Ramifications of Pediatric Distal Tibial Physeal Fractures
DOI:
https://doi.org/10.55576/job.v5i1.60Keywords:
business, management, human resources, cost, value, efficiencyAbstract
Objectives: This study aimed to assess how existing
literature evaluates the cost associated with pediatric
distal tibial physeal fractures.
Design: A scoping review was conducted following
Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines. Searches were
performed in PubMed and MEDLINE for relevant
keywords related to pediatric distal tibial physeal
fractures, cost, and imaging.
Main Outcome Measurements: Cost-effectiveness
Results: The initial search yielded 131 studies; 105 titles
and abstracts were screened, 41 full-text manuscripts
were reviewed, and 7 articles were eligible for inclusion.
Four studies focused on lowering costs by reducing
additional imaging studies, utilizing the Low-Risk Ankle
Rule (LRAR), weight-bearing computed tomography
(WBCT) with cone-beam technology, or not requiring
comparison views in pediatric ankle fractures. One study
found that the Ottawa Ankle Rules (OAR) had sufficient
sensitivity in the pediatric population. Another study
discussed the need for computed tomography (CT) scans
in Salter-Harris (SH) class III or IV fractures due to the
improved ability to apply proper treatment modalities
despite an increased cost.
Conclusions: The scoping review identified a limited
number of studies addressing cost analyses for pediatric
distal tibial physeal fractures. The included studies
focused primarily on reducing costs by optimizing
imaging protocols and implementing clinical decision
rules. Further research is needed to comprehensively
evaluate the cost-effectiveness of various treatment
modalities and the long-term economic implications of
these fractures.
Level of Evidence: IV; Systematic Review of level IV or
higher evidence
Key Words: Business, management, human resources,
cost, value, efficiency
References
Podeszwa, D.A.M. and S.J.M. Mubarak, Physeal Fractures of the Distal Tibia and Fibula (Salter-Har... : Journal of Pediatric Orthopaedics. 2024.
HS, J., et al., Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents. Injury, 2021. 52(4).
K, B., et al., A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics, 2007. 119(6).
RA, T. and H. WL, Treatment and outcomes of distal tibia salter harris II fractures. Injury, 2020. 51(3).
AW, S. and L. AN, Pediatric Ankle Fractures: Concepts and Treatment Principles. Foot and ankle clinics, 2015. 20(4).
TF, K., B. RW, and H. RN, Distal tibial physeal fractures in children that may require open reduction. The Journal of bone and joint surgery. American volume, 1984. 66(5).
M, S., et al., Physeal injuries of the distal tibia: long-term results in 376 patients. International orthopaedics, 2010. 34(4).
H, P., et al., What is the best treatment for displaced Salter-Harris II physeal fractures of the distal tibia? Acta orthopaedica, 2018. 89(1).
E, B. and A. P, BET 1: Can Salter-Harris type I fractures be diagnosed by ultrasound? Emergency medicine journal : EMJ, 2018. 35(5).
I, T., et al., ED point-of-care ultrasound in the diagnosis of ankle fractures in children. The American journal of emergency medicine, 2012. 30(7).
J, K. and H. LI, [Ankle joint injuries in children]. Lakartidningen, 1983. 80(37).
A, M., et al., Salter-Harris type II fractures of the distal tibia: Residual postreduction displacement and outcomes-a STROBE compliant study. Medicine, 2020. 99(9).
JT, L., et al., Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. Journal of pediatric orthopedics, 2009. 29(4).
J, K., H. LI, and L. S, Pronation injuries of the ankle in children. Retrospective study of radiographical classification and treatment. Acta orthopaedica Scandinavica, 1983. 54(1).
F, R., et al., Salter-Harris II fractures of the distal tibia: does surgical management reduce the risk of premature physeal closure? Journal of pediatric orthopedics, 2013. 33(5).
Q, Y., et al., Open reduction and internal fixation for displaced Salter-Harris type II fractures of the distal tibia: a retrospective study of sixty-five cases in children. Journal of orthopaedic surgery and research, 2021. 16(1).
K, B., et al., Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments. Annals of emergency medicine, 2015. 66(5).
B, R., et al., Evaluation of Safety and Cost-Effectiveness of the Low Risk Ankle Rule in One of Europe's Busiest Pediatric Emergency Departments. Pediatric emergency care, 2015. 31(10).
Johnson, C., et al., Business Articles in Shoulder and Elbow Surgery Support Outpatient Total Shoulder Arthroplasty and Identify Factors Impacting Surgery Cost. https://jorthobusiness.org/index.php/jorthobusiness, 2022.
KS, H., N. BU, and B. KJ, Decisions and Incisions: A Value-Driven Practice Framework for Academic Surgeons. The Journal of bone and joint surgery. American volume, 2017. 99(10).
Wells, M., et al., Free-vascularized bone grafts for scaphoid non-unions viable as outpatient procedure? https://www.jorthobusiness.org/index.php/jorthobusiness, 2021.
AL, E., R. AL, and V. P, Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population. The American journal of emergency medicine, 2017. 35(9).
JJ, L., K. A, and S. RJ, Implementation of the Ottawa ankle rule in a university sports medicine center. Medicine and science in sports and exercise, 2002. 34(1).
PD, D. and H. KH, The tuning fork test--a useful tool for improving specificity in "Ottawa positive" patients after ankle inversion injury. Emergency medicine journal : EMJ, 2006. 23(10).
RG, M., et al., Comparison views in extremity injury in children: an efficacy study. Radiology, 1979. 131(1).
HS, H., et al., Weight-Bearing Computed Tomography of the Foot and Ankle in the Pediatric Population. Journal of pediatric orthopedics, 2022. 42(6).
A, N., et al., The role of CT in diagnosis and treatment of distal tibial fractures with intra-articular involvement in children. Injury, 2015. 46(11).
M, L., et al., Acute paediatric ankle trauma: MRI versus plain radiography. Skeletal radiology, 2001. 30(9).
SP, N., P. VA, and P. AV, Rotational injuries of the distal tibial growth plate. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2003. 8(6).
L, C., et al., Do CT scans aid assessment of distal tibial physeal fractures? The Journal of bone and joint surgery. British volume, 2004. 86(2).
F, S., et al., Three-dimensional MR imaging in the assessment of physeal growth arrest. European radiology, 2004. 14(9).
KA, L. and L. M, Traumatic growth arrest of the distal tibia: a clinical and radiographic review. Canadian journal of surgery. Journal canadien de chirurgie, 2005. 48(2).
H, G., et al., MRI for occult physeal fracture detection in children and adolescents. Acta radiologica (Stockholm, Sweden : 1987), 2013. 54(4).
D, H. and O.B. T, Growth disturbance lines after injury of the distal tibial physis. Their significance in prognosis. The Journal of bone and joint surgery. British volume, 1988. 70(2).
P, P., et al., Acute fracture of the distal tibial physis: role of gradient-echo MR imaging versus plain film examination. AJR. American journal of roentgenology, 1996. 166(5).
F, D.A., et al., Outcome of distal tibia physeal fractures: a review of cases as related to risk factors. Injury, 2017. 48 Suppl 3.
M, K. and S. J, Physeal fractures of the lower leg in children and adolescents: Therapeutic results, pitfalls and suggested management protocol - based on the experience of the authors and contemporary literature. Advances in medical sciences, 2018. 63(1).
CB, P. and B. RJ, Pediatric ankle injuries: utilizing the Dias-Tachdjian classification. Skeletal radiology, 2020. 49(4).
Hoon Park, M., PhD, Hyun Woo Kim, MD, PhD, Kun-Bo Park, MD, PhD, Jae Hong Kim, MD, Won June Chang, MD, and Byoung Kyu Park, MD, PhD, Effect of Solitary Osteochondroma on Alignment and Length in the Lower Extremities - PubMed. Journal of pediatric orthopedics, 04/01/2024. 44(4).
J, P., et al., Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study. Journal of orthopaedic trauma, 2019. 33(5).
SM, S., et al., Hospital Costs Following Surgical Complications: A Value-driven Outcomes Analysis of Cost Savings Due to Complication Prevention. Annals of surgery, 2022. 275(2).
M, R., et al., Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Current medical research and opinion, 2009. 25(9).
AK, G., et al., Prediction of total healthcare cost following total shoulder arthroplasty utilizing machine learning. Journal of shoulder and elbow surgery, 2022. 31(12).
PV, R., et al., Cost-Effectiveness Analyses in Orthopaedic Surgery: Raising the Bar. The Journal of bone and joint surgery. American volume, 2017. 99(13).
Gavalas, A., et al., Geriatric Distal Femur Fracture Management Protocols: A Review and Evidence-based Template. https://jorthobusiness.org/index.php/jorthobusiness, 2022.
Perry, C., et al., Medical Management of Common Comorbidities in Elderly Patients with Proximal Femur Fractures. https://www.jorthobusiness.org/index.php/jorthobusiness, 2022.
SP, N., P. VA, and P. AV, Outcome of physeal and epiphyseal injuries of the distal tibia with intra-articular involvement. Journal of pediatric orthopedics, 2005. 25(4).
JS, M. and P. GK, Arthroscopically assisted central physeal bar resection. Journal of pediatric orthopedics, 2006. 26(2).
DA, P. and M. SJ, Physeal fractures of the distal tibia and fibula (Salter-Harris Type I, II, III, and IV fractures). Journal of pediatric orthopedics, 2012. 32 Suppl 1.
A, S., et al., Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children. Acta orthopaedica, 2019. 90(6).
P, P., et al., Rate of abnormal osteoarticular radiographic findings in pediatric patients. AJR. American journal of roentgenology, 2001. 176(4).
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Journal of Orthopaedic Business
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
