Does rigid intramedullary nailing through open growth plates cause harm? A scoping review.

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. Level of evidence: 4.