Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 1;45(9):e804-e809.
doi: 10.1097/BPO.0000000000003024. Epub 2025 Jun 2.

Neonatal Physeal Fracture: What Treatment?

Jade Burnouf  1 , Lys Budiartha  1 , Xavier du Cluzel de Remaurin  1 , Edouard Haumont  1 , Nicolas Vinit  1 , Stephanie Pannier  1 , Eric Desailly  2 , Alina Badina  2
Affiliations

Neonatal Physeal Fracture: What Treatment?

Jade Burnouf et al. J Pediatr Orthop. .

Abstract

Background: The management of diaphyseal fractures in newborns is well established as conservative, involving immobilization without reduction. Newborn physeal fractures (NPF) are rarer lesions, and their management is poorly codified. In the literature, treatment varies from simple monitoring to surgical reduction and osteosynthesis. The aim of this study was to describe the long-term evolution of NPFs according to their location and initial management, and to establish treatment guidelines.

Methods: The first part of the study involved a systematic review of the literature according to PRISMA criteria. For the selected articles, patients were analyzed individually. For each patient, fracture location, time to treatment, type of treatment, and complications were recorded. Complications were classified as "minor" and "major." The second part of the study involved the collection of patients with NPF managed in our department. The same data were recorded.

Results: A total of 28 studies were selected. A total of 108 fractures (including 17 from our series) were analyzed. The most frequent locations were distal humerus (46%), proximal femur (27%), distal femur (13%), and proximal humerus (9%). Treatment was surgical for 17% of fractures. Considering the entire series, we found no significant relationship between the type of treatment and the complication rate. The most complication-prone site was the distal femur. However, these complications were primarily radiologic, with minimal clinical impact. They corrected progressively with growth. No patient required a long-term surgical procedure. No epiphysiodesis was reported.

Conclusion: NPF has a favorable long-term outcome, irrespective of the type of treatment. We recommend that simple immobilization be the preferred treatment option. However, for distal femur fractures, reduction and possibly osteosynthesis should be considered due to the very slow correction of femoral deformities associated with orthopaedic treatment.

Level of evidence: Level IV.

Keywords: birth; epiphysiolysis; fracture-separation; newborn; transphyseal fracture.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Bhat BV, Kumar A, Oumachigui A. Bone injuries during delivery. Indian J Pediatr. 1994;61:401–405.
    1. Rehm A, Promod P, Ogilvy-Stuart A. Neonatal birth fractures: a retrospective tertiary maternity hospital review. J Obstet Gynaecol. 2020;40:485–490.
    1. Madsen ET. Fractures of the extremities in the newborn. Acta Obstet Gynecol Scand. 1955;34:41–74.
    1. Basha A, Amarin Z, Abu-Hassan F. Birth-associated long-bone fractures. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2013;123:127–130.
    1. Ekengren K, Bergdahl S, Ekström G. Birth injuries to the epiphyseal cartilage. Acta Radiol Diagn. 1978;19:197–204.

Publication types