Citation

Pennock AT, Ellis HB, Willimon SC, Wyatt C, Broida SE, Dennis MM, Bastrom T. Orthop. J. Sports Med. 2017; 5(10): 2325967117731567.

Affiliation

Rady Children's Hospital, San Diego, California, USA.

Copyright

(Copyright © 2017, American Orthopaedic Society for Sports Medicine, Publisher SAGE Publishing)

DOI

10.1177/2325967117731567

PMID

29051906

PMCID

PMC5639969

Abstract

BACKGROUND: Intra-articular physeal fractures of the distal femur are an uncommon injury pattern, with only a few small case series reported in the literature.

PURPOSE: To pool patients from 3 high-volume pediatric centers to better understand this injury pattern, to determine outcomes of surgical treatment, and to assess risk factors for complications. STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: A multicenter retrospective review of all patients presenting with an intra-articular physeal fracture between 2006 and 2016 was performed. Patient demographic and injury data, surgical data, and postoperative outcomes were documented. Radiographs were evaluated for fracture classification (Salter-Harris), location, and displacement. Differences between patients with and without complications were compared by use of analysis of variance or chi-square tests.

RESULTS: A total of 49 patients, with a mean age of 13.5 years (range, 7-17 years), met the inclusion criteria. The majority of fractures were Salter-Harris type III fractures (84%) involving the medial femoral condyle (88%). American football was responsible for 50% of the injuries. The initial diagnosis was missed in 39% of cases, and advanced imaging showed greater mean displacement (6 mm) compared with radiographs (3 mm). All patients underwent surgery and returned to sport with "good to excellent" results after 2 years. Complications were more common in patients with wide-open growth plates, patients with fractures involving the lateral femoral condyle, and patients who were casted (P <.05).

CONCLUSION: Clinicians evaluating skeletally immature athletes (particularly football players) with acute knee injuries should maintain a high index of suspicion for an intra-articular physeal fracture. These fractures are frequently missed, and advanced imaging may be required to establish the diagnosis. Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with high rates of return to sport.

Language: en

Keywords

Salter-Harris type III and IV fractures; adolescent knee injury; intra-articular physeal fracture