"Clipping Injury" Fracture of the Epiphysis in the Adolescent Football Player: An Occult Lesion of the Knee

Lf, Rogers; Jones, Scott; Ar, Davis; Dietz, Geral W.

doi:10.2214/ajr.121.1.69

Cited by 19 publications

(12 citation statements)

References 5 publications

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“…This is seen frequently in football players when either the shoulder or helmet of an opposing player impacts the lateral aspect of the knee. Given this common mechanism, this injury has previously been coined a football “clipping injury.” 15 This unique fracture pattern shares several key characteristics with a Tillaux fracture, which is an avulsion injury of the anterior inferior tibiofibular ligament resulting in a Salter-Harris type III fracture of the anterolateral distal tibia. Similar to closure of the distal tibia, closure of the distal femoral physis starts centrally and progresses peripherally toward the perichondral ring.…”

Section: Discussionmentioning

confidence: 90%

Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes

Pennock

Ellis

Willimon

et al. 2017

Orthopaedic Journal of Sports Medicine

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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%). 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.

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Section: Discussionmentioning

confidence: 90%

Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes

Pennock

Ellis

Willimon

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…93 Table 4 shows studies reporting stress changes or stress fracture of the proximal humeral physis in young baseball pitchers. [93][94][95][96][97][98][99][100][101][102][103][104] Often associated with persistent pain in the throwing arm, stress changes of the proximal humeral 34 Distal femur 4 (12) 3 (75) Goldberg 25 53 Distal tibia 19 (33) 5 (26) Burkhard 24 28 Distal tibia 8 (28) 2 (25) Benton 16 203…”

Section: Chronic Physeal Injurymentioning

confidence: 99%

Physeal injuries in children’s and youth sports: reasons for concern?

Caine

DiFiori²,

Maffulli³

2006

Br J Sports Med

291

252

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A systematic review of the literature on the frequency and characteristics of sports related growth plate injuries affecting children and youth in organised sport was carried out. Both acute and chronic physeal injuries related to participation in sports have been reported to occur, although injury incidence data are somewhat limited. Of particular concern is the growing number of stress related physeal injuries, including those affecting the lower extremities. Although most physeal injuries appeared to resolve with treatment and rest, there is also evidence of growth disturbance and deformity. Possible injury risk factors and countermeasures are discussed, and suggestions for directing future research provided.

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“…The normal physis consists of 4 distinct layers. From the epiphysis to the metaphyis these include the reserve zone, the proliferative zone, the zone of maturation and hypertrophy, and finally the zone of provisional calcification [14], [15]. During normal development a physis averages 2-4 mm in thickness with undulating borders.…”

Section: Discussionmentioning

confidence: 99%

Gymnast's wrist in a 12-year-old female with MRI correlation

Ashwell

Richardson

2019

Radiology Case Reports

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We describe a case of chronic overuse injury of the distal radial physis (gymnast’s wrist). While the radiographic appearance of this entity has been reported, there are limited studies highlighting the MR appearance of this entity. This lesion is being seen with increasing frequency in young, elite gymnasts. If this injury goes unrecognized, there is potential for abnormal osseous development, with premature physeal fusion, abnormal joint inclination and even Madelung deformity.

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"Clipping Injury" Fracture of the Epiphysis in the Adolescent Football Player: An Occult Lesion of the Knee

Cited by 19 publications

References 5 publications

Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes

Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes

Physeal injuries in children’s and youth sports: reasons for concern?

Gymnast's wrist in a 12-year-old female with MRI correlation

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