![]() Internal fixation using cannulated screws, or percutaneous fixation with smooth wires are the most commonly chosen treatments, and the choice between the two depends on the fracture pattern. ![]() It is therefore typically reserved for cases where temporary fixation is needed, such as severe open injuries or multitrauma. External fixation is an option, but is technically difficult, as it requires placing multiple percutaneous pins in the relatively small distal femoral epiphysis or spanning the knee for stability.Closed manipulation and casting is an option, although Salter-Harris II fractures of the distal femur have significant potential for instability, which could lead to malunion, and continued micromotion at the fracture site may encourage physeal arrest (Lombardo, 1977).Observation is not indicated for displaced fractures (Graham, 1990).Treatment options for Salter-Harris II distal femur fractures include closed manipulation and casting, percutaneous fixation, external fixation, or open reduction with internal fixation. MRI is becoming more accessible and inexpensive, and has the advantage of avoiding further damage or displacement to the physis (Segal, 2011). When there is a concern for a subtle physeal injury, it may be more prudent to obtain an MRI. However, this remains controversial as most injuries can be seen on regular x-rays. In the past, stress radiographs have been recommended to visualize physeal displacement. In rare cases, patients can have distal femoral physeal injuries without displacement, which can be difficult to appreciate on plain radiographs. Imaging of the entire femur should be considered in most cases, especially in incidences of high energy trauma, to ensure the absence of segmental fractures including femoral neck fractures, or other associated injuries. X-Rays (AP and lateral views) of the affected knee are the standard modality for diagnosing distal femur fractures. Severe deformity or displacement of the distal fragment should raise concern for possible vascular injury prompting ABIs or vascular consult as indicated. Patients typically have pain, swelling about the knee, possible deformity, and an inability to bear weight on the affected leg (Azar, 2017). They are rare injuries comprising only 7% of all pediatric lower extremity fractures. Because of the undulating nature of the distal femoral physis, and the propensity for Salter-Harris 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 (Thomson, 1995).ĭistal femur fractures in children are typically related to significant trauma, such as falls, motor vehicle accidents, or contact sports. Restoration of normal limb alignment requires fracture reduction and fixation in a near-anatomic position, without risking further damage to the growing physis (Czitrom, 1981). Even though distal femur fractures are relatively uncommon injuries, they can have significant implications for limb alignment and future growth (Arkader, 2007 Basener, 2009 Eid, 2002). Salter-Harris II fractures of the distal femur are the most common pattern in children, and will be the focus of this review. Growth arrest (up to 50% incidence) is the most common complication following distal femoral physeal injuriesĭistal femur fractures in children can have various fracture patterns, including supracondylar fractures, T-condylar fractures, or fractures of any pattern from the Salter-Harris classification.Reduction and fixation is typically required for distal femoral physeal injuries.Salter Harris II fractures are the most common distal femoral physeal injury.Distal femur fractures in children commonly involve the physis.Study Guide Distal Femur Fractures Key Points:
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