Growth Disturbance After Distal Femoral Growth Plate Fractures in Children: A Meta-Analysis

Basener, Clint; Mehlman, Charles T.; DiPasquale, Thomas

doi:10.1097/bot.0b013e3181a4f25b

Cited by 116 publications

(124 citation statements)

References 19 publications

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“…Multiple studies have shown a fairly high rate following physeal injuries to the distal femur; although the reported rates for physeal arrest are variable among individual studies, it can be greater than 60 % [1-3, 5, 15]. Although there is a greater incidence of absolute growth disturbance in patients treated with fixation, there is a decreased incidence of clinically significant growth disturbance, defined as a leg length discrepancy ≥1.5 cm and/or 5°of varus or valgus deformity [2]. Highenergy distal femur growth plate fractures have a significantly higher rate of growth disturbance compared with low-energy fractures [3].…”

Section: Complicationsmentioning

confidence: 97%

“…Isolated distal femoral physeal injuries are rarely seen [1,2]. They represent 5 % of all physeal injuries [3].…”

Section: Distal Femoral Physeal Fracturesmentioning

confidence: 99%

“…They represent 5 % of all physeal injuries [3]. Salter-Harris II fractures are the most common type [1,2,4,5]. They may be uncommon fractures, but they frequently have long-term complications, such as growth disturbance, with subsequent development of leg length discrepancy and/or angular deformities [1,2].…”

Section: Distal Femoral Physeal Fracturesmentioning

confidence: 99%

“…Late complications are more common than acute complications [6], and overall, growth arrest is the most commonly observed complication [1][2][3]. Growth disturbances, in the form of either leg length discrepancy and/or angular deformity, result from physeal arrest.…”

Section: Complicationsmentioning

confidence: 99%

“…Skeletal growth of the overall leg is about 23 mm per year. The distal femoral physis grows the fastest of all physes and is the main growth center of the lower leg, contributing approximately 40 % of lower extremity growth [1,2,6]. Overall, the knee contributes ∼15 mm, since the distal femoral physis grows at a rate of about 9-10 mm per year and the proximal tibia physis grows 5-6 mm per year [6].…”

Section: Years Inmentioning

confidence: 99%

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Physeal fractures about the knee

Little

Milewski

2016

Curr Rev Musculoskelet Med

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While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.

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Section: Complicationsmentioning

confidence: 97%

“…Isolated distal femoral physeal injuries are rarely seen [1,2]. They represent 5 % of all physeal injuries [3].…”

Section: Distal Femoral Physeal Fracturesmentioning

confidence: 99%

Section: Distal Femoral Physeal Fracturesmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Years Inmentioning

confidence: 99%

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Physeal fractures about the knee

Little

Milewski

2016

Curr Rev Musculoskelet Med

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Acute Knee Injuries in Children and Adolescents

2021

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ne-third of all musculoskeletal complaints in primary care officesareduetokneepain. 1 Upwardof60millionchildrenaged 6 to 18 years participate in organized sports each year in the US. 2 Parallelingthislevelofparticipationisasignificantnumberofsportsrelated injuries, with the knee being one of the most commonly injured joints: up to 54% of young athletes have knee pain annually. 3 There are anestimated2.5millionsports-relatedkneeinjuriesinadolescentseach year,and60%ofsports-relatedsurgeriesinhighschoolathletesinvolve the knee. [4][5][6] Certain sports are considered high risk, with football, soccer,andbasketballaccountingforthelargestproportionofsports-related kneeinjuriesintheUS. 7 Studiesinhighschoolathleteshaveconsistently foundthatadolescentgirlshaveasignificantlyhigherriskofseriousknee injury compared with boys. 7 Knee injuries can be broken down into 2 basic categories: those due to acute, traumatic events, and those due to cumulative, repetitive microtrauma, or so-called overuse injuries. The presenting history will typically guide the clinician in determining whether the patient is presenting with an acute or overuse injury. Although many acute knee injuries in children and adolescents are contusions and lacerations that are often self-limited, several conditions require specific identification in order to treat them properly and achieve ideal outcomes. 7 This article will review the diagnosis and management of acute knee injuries in children and adolescents, with a focus on specific conditions requiring the treating pediatrician's attention. Discussion General ConsiderationsIn the setting of acute knee trauma, there are a few keys to the physical examination. The knee should be inspected for obvious bony de-formity or opening of the skin. The presence of a knee effusion is one of the most significant physical findings. A knee effusion represents a hemarthrosis and is distinctly different from mere soft tissue swelling. In acute trauma, knee effusions are an indication of a likely severe injury, including fracture, tear to the meniscus, tear of a ligament, or a joint dislocation. Up to 70% of patients aged 9 to 14 years with traumatic effusion have had a serious intra-articular injury, with the 3 most common injuries being lateral patellar dislocation, anterior cruciate ligament (ACL) tears, and fracture. 8 Therefore, an acute traumatic effusion is an indication for radiography and possibly advanced imaging. The clinician must remember that up to 56% of patients presenting with a traumatic effusion may have no visible injury on plain radiographs, and advanced imaging may be indicated. 8 The clinician should assess weight-bearing status and examine gait where possible. If the patient cannot bear weight, it is important to ensure while lying supine that they can do a straight leg raise: demonstrating the ability to actively lift the straight leg off the examining table rules out that the patient has disrupted their extensor mechanism. A thorough neurovascular examination should be done of the leg distal to th...

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