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Physeal Fractures in Adolescent Climbers: Current State of the Literature
Emily Dayoub, BA
1, Katrianna Urrea, BA
1, Stella den Hengst, BSc
2, Carrie Cooper, DPT
3, Krystle R. Tuaņo, MD
4; Shawn Diamond, MD
5(1)Texas Tech University Health Sciences El Paso, El Paso, TX, (2)Massachusetts General Hospital, Boston, MA, (3)Doctor of Physical Therapy, Salt Lake City, UT, (4)Massachusetts General Hospital | Harvard Medical School, Boston, MA, (5)Department of Surgery, Texas Tech University Health Science Center El Paso, El Paso, TX
Introduction: Stress-related physeal fractures are increasingly reported in adolescent climbers, likely due to early sport specialization and high training volumes. We performed a meta-analysis to characterize their presentation, imaging practices, treatment approaches, and reported outcomes based on published patient-level data.
Materials&Methods: A structured literature review was performed using PubMed, Google Scholar, and ScienceDirect. Articles meeting inclusion criteria were case reports and series involving pediatric climbers with closed physeal fractures of the digits or wrist. Extracted variables included age, sex, climbing level, injury classification, clinical features, imaging modality, treatment type, and recovery. Descriptive statistics were used to summarize findings. A total of 97 injuries across 82 patients were included from 11 studies. Limited aggregate data from Schöffl et al. contributed 30 additional injuries from 27 patients, 10 of which required surgical treatment. These were included in summary statistics but excluded from inferential analyses due to lack of patient-level detail.
Results: Of 1,106 peer-reviewed articles screened, 11 met inclusion criteria, comprising 97 injuries across 82 patients (mean age 14.4years, N=56; 82% male). Among those with documented climbing levels (N=59), 66% were elite or high elite. Salter-Harris III (SH-III) fractures were most common (88%, N=75). The predominant presenting features were tenderness (100%) and swelling (82%), while a clear inciting event was rare (3%). Imaging included radiographs in all cases, with selective use of MRI (46%) and ultrasound (34%). The middle phalanx (95.52%) and third digit (62.69%) were most frequently affected.
Most injuries were initially treated with multimodal, nonoperative treatment. The most common components included climbing cessation, immobilization, functional therapy, and NSAIDs. Eleven injuries failed initial management, with 10 (90.90%) ultimately requiring surgery, most commonly after treatment with climbing cessation and immobilization.
Return to climbing was reported in 96.51% of cases, with an average return time of 6.1 months. Full range of motion was regained in 94.87% of patients, and 88.24% retained their pre-injury climbing ability. Fracture union was confirmed in 72%, with an average union time of 7.7 months. At final follow-up, 38.98% had persistent deformity, and 10.53% reported residual pain.
Conclusion: Physeal fractures in adolescent climbers predominantly affect elite-level males, typically presenting without a clear acute inciting event, with SH-type III injuries of insidious onset being the most common. While multimodal nonoperative treatment generally resulted in fracture union and favorable outcomes, the variability in treatment strategies highlights the need for prospective studies to guide evidence-based management for this growing athletic population.
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