TY - JOUR
T1 - Intra-articular physeal fractures of the distal femur
T2 - A frequently missed diagnosis in adolescent athletes
AU - Pennock, Andrew T.
AU - Ellis, Henry B.
AU - Willimon, Samuel C.
AU - Wyatt, Charles
AU - Broida, Samuel E.
AU - Dennis, M. Morgan
AU - Bastrom, Tracey
N1 - Funding Information:
*Address correspondence to Andrew T. Pennock, MD, 7960 Birmingham Drive, 4th Floor, San Diego, CA 92123, USA (email: apennock@rchsd.org). †Rady Children’s Hospital, San Diego, California, USA. ‡Sports Medicine Center, Texas Scottish Rite Hospital, Dallas, Texas, USA. §Department of Orthopedic Surgery, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA. One or more of the authors has declared the following potential conflict of interest or source of funding: H.B.E. is a paid consultant for Smith & Nephew and receives funding for the ROCK (Research in Osteochondritis of the Knee) Study Group. Ethical approval for this study was obtained from the University of California, San Diego, Human Research Protections Program (project No. 151449X).
Publisher Copyright:
© The Author(s) 2017.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - Adolescent knee injury
KW - Intra-articular physeal fracture
KW - Salter-harris type III and IV fractures
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U2 - 10.1177/2325967117731567
DO - 10.1177/2325967117731567
M3 - Article
C2 - 29051906
AN - SCOPUS:85032932004
SN - 2325-9671
VL - 5
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
IS - 10
M1 - 2325967117731567
ER -