Salter-Harris I Fracture of the Distal Femur

Living reference work entry

Abstract

Salter-Harris I and II fractures of the distal femur in children are relatively uncommon injuries but have significant implications for limb alignment and future growth. Restoration of normal limb alignment requires fracture reduction and fixation in a near-anatomic position, without risking further damage to the growing physis. Because of the undulating nature of the distal femoral physis, and the propensity for Salter-Harris I and II fractures in this location to cross different zones of the growing physis, these fractures are among the most likely to lead to permanent physeal arrest. This chapter discusses the nature of these injuries, the author’s preferred fixation technique, and the necessity to monitor patients long term for potential growth arrest.

A 10-year-old boy presented after falling on a trampoline with pain and deformity in the left knee. X-rays in the emergency department revealed a displaced fracture through the left distal femoral physis. Under a general anesthetic, the fracture was reduced and pinned percutaneously. A supplemental long leg cast was used to immobilize the knee. The pins were removed under a second general anesthetic about 4 weeks later, and physical therapy for knee range of motion and quadriceps strengthening was initiated. The patient regained normal function of the knee and was subsequently followed to evaluate for a physeal arrest.

References and Suggested Readings

  1. Arkader A, Warner WC Jr, Horn BD, Shaw RN, Wells L (2007) Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop 27(6):703–708CrossRefPubMedGoogle Scholar
  2. Cassebaum WH, Patterson AH (1965) Fractures of the distal femoral epiphysis. Clin Orthop 41:79–91CrossRefPubMedGoogle Scholar
  3. Czitrom AA, Salter RB, Willis RB (1981) Fractures involving the distal epiphyseal plate of the femur. Int Orthop 4(4):269–277PubMedGoogle Scholar
  4. Dahl WJ, Silva S, Vanderhave KL (2014) Distal femoral physeal fixation: are smooth pins really safe? J Pediatr Orthop 34(2):134–138CrossRefPubMedGoogle Scholar
  5. Garrett BR, Hoffman EB, Carrara H (2011) The effect of percutaneous pin fixation in the treatment of distal femoral physeal fractures. J Bone Joint Surg Br 93(5):689–694CrossRefPubMedGoogle Scholar
  6. Graham JM, Gross RH (1990) Distal femoral physeal problem fractures. Clin Orthop 255:51–53Google Scholar
  7. Riseborough EJ, Barrett IR, Shapiro F (1983) Growth disturbances following distal femoral physeal fracture-separations. J Bone Joint Surg Am 65(7):885–893CrossRefPubMedGoogle Scholar
  8. Roberts JM (1973) Fracture separation of the distal femoral epiphyseal growth line. J Bone Joint Surg Am 55:1324Google Scholar
  9. Thomson JD, Stricker SJ, Williams MM (1995) Fractures of the distal femoral epiphyseal plate. J Pediatr Orthop 15(4):474–478CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNemours Children’s Speciality CareJacksonvilleUSA

Section editors and affiliations

  • Eric D. Shirley
    • 1
  1. 1.Pediatric Orthopaedic AssociatesAltantaUSA

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