Intra-articular physeal fractures of the distal femur: A frequently missed diagnosis in adolescent athletes

Andrew T. Pennock, Henry B. Ellis, Samuel C. Willimon, Charles Wyatt, Samuel E. Broida, M. Morgan Dennis, Tracey Bastrom

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


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 amean 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%). 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.

Original languageEnglish (US)
Article number2325967117731567
JournalOrthopaedic Journal of Sports Medicine
Issue number10
StatePublished - Jan 1 2017


  • Adolescent knee injury
  • Intra-articular physeal fracture
  • Salter-harris type III and IV fractures

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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