BACKGROUND Recent evidence has identified a strong association between growth hormone therapy and physeal injuries in the lower extremity; however, few studies have investigated this association in the upper extremity. QUESTIONS/PURPOSES (1) Do pediatric patients with physeal tension injuries of the shoulder and elbow have higher odds of having exposure to recombinant growth hormone therapy than matched controls? (2) Are the odds of having exposure to recombinant growth hormone therapy in physeal tension injuries different when stratified by shoulder and elbow injuries? METHODS Using a matched case-control study design, patients between 4 and 18 years of age treated at a large, urban, academic center from February 1, 2016, to November 6, 2023, were identified by ICD-10 codes using EPIC SlicerDicer, an electronic medical record-based data mining tool. Patients diagnosed with physeal tension injuries in the shoulder or elbow were included in the case group, and those with midshaft radius, metaphyseal radius, or both-bone forearm fractures were included in the control group. A total of 618 patients with physeal injuries and 1244 with non-physeal fractures were identified and screened for inclusion. After further chart review to confirm diagnoses, 46% (283) of patients with physeal injuries and 54% (670) of patients with non-physeal fractures were included. A further 6% (16) of patients with physeal injuries and 2% (15) of patients with non-physeal injuries were excluded due concomitant dislocations or missing data, resulting in 267 eligible patients with physeal injuries and 655 eligible patients with non-physeal fractures. Two patients with concurrent elbow and shoulder physeal injuries were additionally excluded from stratified analyses. Patients with physeal injuries and non-physeal fractures were 1:1 matched by age ± 0.5 years, sex, and BMI ± 2 kg/m2. In all, 522 patients were included in the analysis, including 261 patients with physeal injuries and 261 with non-physeal fractures. The mean ± SD ages for both patient groups was 13 ± 2 years (p = 0.44), 88% (229 of 261) of all participants were male, and the mean BMIs were 19.9 ± 3.0 kg/m2 and 19.4 ± 3.0 kg/m2 (p = 0.11), respectively. Growth hormone exposure was compared between patients with physeal injuries and non-physeal fractures using a conditional logistic regression model. RESULTS Overall, 4% (10 of 261) of patients with physeal injuries had exposure to growth hormone therapy as compared with 2% (4 of 261) of patients with non-physeal fractures (OR 2.5 [95% confidence interval 0.8 to 8.0]). Subgroup analyses of shoulder and elbow injuries demonstrated no difference in growth hormone exposure between patients with physeal injuries and non-physeal fractures (OR 2 [95% CI 0.4 to 10.2] and OR 3 [95% CI 0.6 to 14.9], respectively). CONCLUSION In light of these results, clinicians may not need to advise precaution against sports or other activities that put the upper extremity physes under stress when treating patients with growth hormone supplementation therapy. Future multicenter studies, however, are indicated to further investigate for the existence of any subtle association between growth hormone therapy and upper extremity physeal injuries relative to the large association previously noted in the lower extremity in pediatric and adolescent patients. LEVEL OF EVIDENCE Level III, therapeutic study.

中文翻译：

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生长激素治疗与上肢骨骺张力损伤之间没有关联：一项匹配的病例对照研究。


背景最近的证据表明，生长激素治疗与下肢骺板损伤之间存在密切关联。然而，很少有研究调查上肢的这种关联。问题/目的 (1) 肩部和肘部骺肌张力损伤的儿科患者接受重组生长激素治疗的几率是否比匹配对照更高？ (2) 按肩部和肘部损伤分层时，在骺肌张力损伤中接受重组生长激素治疗的几率是否不同？方法 采用匹配的病例对照研究设计，使用 EPIC SlicerDicer 通过 ICD-10 代码识别 2016 年 2 月 1 日至 2023 年 11 月 6 日在大型城市学术中心接受治疗的 4 至 18 岁患者。一种基于电子病历的数据挖掘工具。诊断为肩部或肘部骺板张力损伤的患者纳入病例组，桡骨中段、干骺端或前臂双骨骨折患者纳入对照组。共有 618 名骺板损伤患者和 1244 名非骺板骨折患者被识别并筛选纳入。经过进一步的图表审查以确认诊断后，纳入了 46% (283) 的骨骺损伤患者和 54% (670) 的非骨骺骨折患者。另外 6% (16) 的骺损伤患者和 2% (15) 的非骺损伤患者因伴随脱位或数据缺失而被排除，从而导致 267 名符合资格的骺伤患者和 655 名符合资格的非骺伤患者骨折。另外，分层分析中还排除了两名同时患有肘部和肩部骨骺损伤的患者。 骺损伤和非骺骨折患者按年龄 ± 0.5 岁、性别和 BMI ± 2 kg/m2 进行 1:1 匹配。总共有 522 名患者参与了分析，其中 261 名骺板损伤患者和 261 名非骺板骨折患者。两个患者组的平均±标准差年龄均为 13±2 岁 (p = 0.44)，所有参与者中 88%（261 人中的 229 人）为男性，平均 BMI 分别为 19.9 ± 3.0 kg/m2 和 19.4 ± 3.0 kg/m2 m2 (p = 0.11) 分别。使用条件逻辑回归模型比较骺板损伤和非骺板骨折患者的生长激素暴露情况。结果 总体而言，4%（261 名骨骺损伤患者中的 10 名）接受过生长激素治疗，相比之下，2%（261 名骨骺骨折患者中的 4 名）接受过生长激素治疗（OR 2.5 [95% 置信区间 0.8 至 8.0] ）。肩部和肘部损伤的亚组分析表明，骺板损伤和非骺板骨折患者的生长激素暴露没有差异（分别为 OR 2 [95% CI 0.4 至 10.2] 和 OR 3 [95% CI 0.6 至 14.9]）。结论 根据这些结果，临床医生在治疗接受生长激素补充疗法的患者时，可能不需要建议预防性运动或其他会使上肢肌群承受压力的活动。然而，未来的多中心研究将进一步调查生长激素治疗与上肢骺损伤之间是否存在微妙的关联，相对于之前在儿科和青少年患者的下肢中注意到的巨大关联。证据级别 III 级，治疗研究。