Traumatic injuries of the distal femoral physis. Retrospective study on 151 cases

doi:10.1016/S0020-1383(01)00109-7

Injury

Volume 33, Issue 3, April 2002, Pages 251-255

https://doi.org/10.1016/S0020-1383(01)00109-7 Get rights and content

Abstract

This is a retrospective study on a series of 151 injuries involving the distal femoral physis. The average age at the time of injury was 12.3 years. Patients were followed for an average of 8.2 years. The complications encountered were not insignificant and the satisfactory results were relatively low (64.9%). The juvenile age group was the most affected with complications. Salter–Harris type II injuries predominated (43.0%) and they did not have a good prognosis as previously suggested. Symptomatic knee ligamentous laxity was found in 12 patients (7.9%). Compartment syndrome is a devastating complication that occurred in 2 cases (1.3%). We stress the point that a child with a physeal injury of the distal femur should be followed for several years after injury and preferably until skeletal maturity. The surgeon must have high index of suspicious for compartment syndrome. Physeal injuries of the distal femur and in particular Salter and Harris type II should be reduced anatomically and fixed well. Whether this should be achieved by closed or opened means, requires a controlled prospective study to provide a confident answer.

Introduction

The lower femoral epiphyseal plate contributes 70% of the longitudinal growth of the femur and 40% of the overall growth of the lower extremity [1]. Injury of the distal femoral physis is not uncommon and rather a serious injury [2].

Salter and Harris [3], produced a widely used classification. They believed that this classification would be of a great prognostic value and might be useful in making decision for treatment. We undertook this study to report the outcome in 151 cases of traumatic injuries of the distal femoral physis.

Section snippets

Methods

A retrospective review was carried out of 151 patients with traumatic injuries of the distal femoral physis managed at University of Alexandria Hospitals, Alexandria, Egypt between 1980 and 1996. All patients were followed-up until complete fusion of the distal femoral growth plate. Children with associated neurologic abnormalities, muscular dystrophy, metabolic bone disease, congenital abnormality of the skeleton and inflammatory joint disease were excluded from this study.

All patients were

Incidence

There were 129 male and 22 female patients, a ratio of approximately 6:1. The average age at injury was 12.3 years ranging from 10 months to 16 years and 9 months. These were 11 injuries (7.3%) in children under the age of 2 years. In the juvenile age, range 2 to less than 11 years, there were 49 injuries (32.4%) while 91 patients (60.3%) were injured in the adolescent age range (11 years or more). The injury was on the left side in 91 (60.3%) and on the right in 60 patients (39.7%).

Mechanism of injury and associated injuries

Discussion

The epiphysis at the distal femur is the largest and fastest growing in the body. Its injury is more common than injuries of growth plates elsewhere in the lower limb. From one century to the next, the clinical presentation of distal femoral physeal injuries has changed considerably. Previously the concern was the management of the injury in the acute phase. Currently, the main concern is the premature closure of the physis leading to progressive angulation and shortening, and dealing with

Conclusions

Many of the patients with this injury are healthy youngsters. With appropriate treatment, they should return to normal activities. For younger children with remaining growth, the potential for shortening and angular deformity is significant. We stress the point that a child with a physeal fracture of the distal femoral growth plate should be followed clinically and radiologically for at least few years after injury and preferably until skeletal maturity. Compartment syndrome should always be

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^☆: Study conducted at the University of Alexandria Hospitals, Alexandria, Egypt.

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Traumatic injuries of the distal femoral physis. Retrospective study on 151 cases☆

Abstract

Introduction

Section snippets

Methods

Incidence

Mechanism of injury and associated injuries

Discussion

Conclusions

Fractures of the distal femoral epiphysis

Clin. Orthop.

Fractures and separations of the knee

Injuries involving the epiphyseal plate

J. Bone Joint Surg. Am.

Injuries of the distal femoral growth plate and epiphysis: should open reduction be performed?

Aust. N. Z. J. Surg.

Fractures involving the distal femoral epiphyseal growth line

South. Med. J.