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.
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References and Suggested Readings
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