Physeal fractures about the knee

Abstract

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.

Substantial decrease in paediatric lower extremity fracture rates in German hospitals in 2017 compared with 2002: an epidemiological study

“…In summary, paediatric proximal tibial fractures have a high complication rate. We believe that the increase in proximal tibial fractures is also owing to a higher detection rate because of the increased use of computed tomography and magnetic resonance imaging [25].…”

Orthopaedic case management: A balancing act

“…Physeal fracture configurations are dependent upon many factors, including the size and age of the animal, the magnitude and direction of force that causes the injury, the particular physis involved, its shape, any pre-existing local physeal abnormalities and the associated soft tissues of the region. The uncommon configuration of the physeal fracture reported by Valk and Schumacher (complex type 3 Salter-Harris fracture of the distal femur) is also uncommon in other species, including children (Berg et al 1984;Arkader et al 2007;Little and Milewski 2016;Pennock et al 2017). This type of fracture in adolescent children is recognised to have a delay of diagnosis in almost 40% of cases, particularly when the fracture is minimally displaced (Pennock et al 2017).…”

Extensor Mechanism Injury in the Pediatric Population—A Clinical Review

“…Screw fixation is recommended over Kirschner wire (K-wire) fixation given that it is biomechanically superior and offers compression at the fracture site. 25 Smooth wire fixation should be reserved for younger patients in whom a closed reduction is achieved, and screw fixation may not be feasible secondary to fragment size. Preoperative planning should include scrutinization of the available imaging to determine the need for an arthrotomy or arthroscopy to aid an articular reduction.…”