Fracture of the distal epiphysis of the femur
Keywords:
epiphyseal fractures, knee joint, distal femoral epiphysis, fractures in the childAbstract
Introduction: traumatic injuries of the epiphysis are frequent in the pediatric age groups. The knee joint is one of the most involved, especially, distal femoral epiphysis.
Objective: update and provide information concerning fractures of the distal femoral epiphysis.
Method: search and analysis of information was gathered over a period of 61 days (April 1 to May 31, 2022) and the following words were used as a key: physeal injuries, physeal injuries and knee, physeal fractures aroundtheknee, distal femoral physeal fracture. Based on the information obtained, a bibliographic review was made of a total of 153 articles published in the PubMed, Hinari, SciELO and Medline databases, using the search engine and reference manager EndNote: 34 selected citations were used for the review, 33 of them from the last five years.
Development: the most important anatomical characteristics related to the mechanism of production were mentioned. The Salter Harris classification was pointed too. The main treatment modalities, both conservative and surgical, based on the classification, were presented. Regarding complications, the most reported in the literature were described.
Conclusions: fractures of the distal femoral epiphysis are complex injuries. For a better understanding, it is important to know the mechanisms of production, as well as the classification based on the degree of severity. Both conservative and surgical therapeutics have precise indications based on the degree and displacement of epiphysis affection.
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References
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2. Christino MA, Kocher MS. The Paediatric Knee. En: LaPrade RF, Chahla J. Evidence Based Management of Complex Knee Injuries. Philadelphia: Elsevier; 2021. p.396-415.
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4. Andras L, Smith BG. Fractures of the distal femoral physis. En: Waters PM, Skaggs DL, Flynn JM. Rockwood and Wilkin's Fractures in Children. 9ed. Philadelphia: Wolters Kluwer; 2020. p.1375-1416.
5. Cruz AI Jr, Richmond CG, Tompkins MA, Heyer A, Shea KG, Beck JJ. What's new in pediatric sports conditions of the knee? J Ped Orthop [Internet]. 2018 Feb [citado 30 Mayo 2022]; 38(2):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29189538/
6. Bailey MEA, Wei R, Bolton S, Richards RH. Paediatric injuries around the knee: Bony injuries. Injury [Internet]. 2020 Mar [citado 30 Mayo 2022]; 51(3): [aproximadamente 8 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32067766/
7. Pennock AT, Ellis HB, Willimon SC, Wyatt C, Broida SE, Dennis MM, et al. Intra-articular physeal fractures of the distal femur: a frequently missed diagnosis in adolescent athletes. Orthop J Sports Med [Internet]. 2017 Oct [citado 30 Mayo 2022]; 5(10):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29051906/
8. Levene R, Fein DM, Grossman JP. Knee trauma. Ped Rev [Internet]. 2022 Jan [citado 30 Mayo 2022]; 43(1): [aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35229128/
9. Samet JD. Pediatric sports injuries. Clin Sports Med [Internet]. 2021 Oct [citado 30 Mayo 2022]; 40(4):[aproximadamente 18 p.]. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0278-5919(21)00051-X
10. Young EY, Stans AA. Distal femoral physeal fractures. J Knee Surg [Internet]. 2018 Jul [citado 30 Mayo 2022]; 31(6):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29490406/
11. Diallo M, Soulama M, Sidibé A, Ouédraogo S, Dakouré PWH. Reduction of neglected displaced fractures of the distal femoral physis. JBJS Essent Surg Tech [Internet]. 2021 Mar [citado 30 May 2022]; 11(1):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34123549/
12. Sawyer JR, Spence DD. Fractures and dislocations in children. En: Azar FM, Beaty JH. Campbell's Operative Orthopaedics. 14ed. Philadelphia: Elsevier; 2021. p.1593-6.
13. Wilkins KE. Fracturas extra-articulares de la rodilla. En: Pablos J, Gónzalez Herranz P. Apuntes de Fracturas Infantiles. Madrid: Ergon; 1999. p.293-301.
14. Kowalczyk AD, Geminiani ET, Dahlberg BW, Micheli LJ, Sugimoto D. Pediatric and adolescent figure skating injuries: a 15-year retrospective review. Clin J Sport Med [Internet]. 2021 Mayo [citado 30 Mayo 2022]; 31(3):[aproximadamente 14 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30985309/
15. Razzi M, Nordin A. A rare case of non-contact Salter Harris type 2 fracture of distal femur during a football match. Med J Malaysia [Internet]. 2018 Oct [citado 30 May 2022]; 73(5): [aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30350822/
16. Adams AJ, Mahmoud MAH, Wells L, Flynn JM, Arkader A. Physeal fractures of the distal femur: does a lower threshold for surgery lead to better outcomes? J Ped Orthop B [Internet]. 2020 Jan [citado 30 May 2022]; 29(1):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31425335/
17. Woernle M, Fechisin JP. The Pediatric Knee and proximal tibia. Ped Clin N Am [Internet]. 2020 [citado 30 Mayo 2022]; 67:[aproximadamente 14 p.]. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0031395519301373
18. Behera P, Gopinathan NR, Kumar A, Saibaba B, Sudesh P, John R. Distal femoral physeal crush injury with metaphyseal comminution-a report of two cases and a new perspective to physeal injury. Chin J Traumatol [Internet]. 2017 Dec [citado 30 Mayo 2022]; 20(6): [aproximadamente 3 p.]. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/29203221/
19. Rickert KD, Hosseinzadeh P, Edmonds EW. What's new in pediatric orthopaedic trauma: the lower extremity. J Ped Orthop [Internet]. 2018 Sep [citado 30 May 2022]; 38(8):[aproximadamente 5 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29975292/
20. Bellamy JT, Ward LA, Fletcher ND. Evaluation of pediatric distal femoral physeal fractures and the factors impacting poor outcome requiring further corrective surgery. J Ped Orthop B [Internet]. 2021 Jan [citado 30 Mayo 2022]; 30(1):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32317562/
21. MacDonald J, Rodenberg R, Sweeney E. Acute knee injuries in children and adolescents: a review. JAMA Ped [Internet]. 2021 Jun [citado 30 Mayo 2022]; 175(6):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33749718/
22. Othman Y, Hassini L, Fekih A, Aloui I, Abid A. Uncommon floating knee in a teenager: a case report of ipsilateral physeal fractures in distal femur and proximal tibia. J Orthop Case Rep [Internet]. 2017 May-Jun [citado 30 Mayo 2022]; 7(3):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29051887/
23. Lorenzen MM, Birkelund L, Laursen JO. Severely dislocated distal physeal femur fracture in a 13-year-old girl. Ugeskr Laeger [Internet]. 2019 Jun [citado 30 Mayo 2022]; 181(24):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31267954/
24. Franklin CC, Skaggs DL, Weiss J. Physeal Fractures About the Knee. En: Scott WN. Insall & Scott Surgery of the Knee. 6 ed. Philadelphia: Elsevier; 2018. p.1281-3.
25. Tuca M, Pineda T. Lesiones traumáticas de rodilla en niños y adolescentes. Rev Med Clín Condes [Internet]. 2021 [citado 30 Mayo 2022]; 32(3):[aproximadamente 10 p.]. Disponible en: https://reader.elsevier.com/reader/sd/pii/S0716864021000493?token=C2E31F930642E668279523E9345401444F4EE23F821068CAADA66C974C774EAE2DE5117A2067CE7BFF4368BDE66226D4&originRegion=us-east-1&originCreation=20220331204401
26. Ozturk M, Yurtbay A, Keskin D, Polat AV, Selcuk MB. Subperiosteal hemorrhage due to a distal femoral physeal fracture in a neonate. North Clin Istanb [Internet]. 2018 Aug [citado 30 Mayo 2022]; 6(3):[aproximadamente 2 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31650122/
27. Ramo B, Ellis HB. Lower Extremity Injuries. En: Herring JA. Tachdjian's Pediatric Orthopaedics. 6ed. Philadelphia: Elsevier; 2022. p.1332-1344.
28. Bonnevie F, Allington N. Growth arrest after a physeal femur fracture in a child. Rev Med Liege [Internet]. 2021 Oct [citado 30 Mayo 2022]; 76(10):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34632737/
29. Conchin A, Ferrara MA, Kaux JF. Stress fracture of the distal femoral growth plate in a young Belgian table tennis champion. Rev Med Liege [Internet]. 2020 Jul [citado 30 Mayo 2022]; 75(7-8):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32779897/
30. Wu X, Xia J, Li J, Sun J, Shen X. Distal femoral physeal fractures after neonatal osteomyelitis: A case report. Medicine (Baltimore) [Internet]. 2019 Mayo [citado 30 May 2022]; 98(18):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31045792/
31. Gibly RF, Georgopoulos G, Carry PM, Miller NH. Lower extremity physeal fractures and post-traumatic surgical deformities; National Trauma Data Bank and institutional cohorts. J Clin Orthop Trauma [Internet]. 2022 Mar [citado 30 Mayo 2022]; 27:[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35310787/
32. Sabharwal S, Sabharwal S. Growth plate injuries of the lower extremity: case examples and lessons learned. Indian J Orthop [Internet]. 2018 Sep-Oct [citado 30 Mayo 2022]; 52(5):[aproximadamente 7 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30237603/
33. Neubauer T. Pediatric injuries of the knee joint. Unfallchirurg [Internet]. 2019 Jan [citado 30 Mayo 2022]; 122(1):[aproximadamente 14 p.]. Disponible en: https://link.springer.com/article/10.1007/s00113-018-0587-3
34. van den Broek M, Oussedik S. Paediatric fractures around the knee. Br J Hosp Med (Lond) [Internet]. 2017 Aug [citado 30 Mayo 2022]; 78(8):[aproximadamente 5 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28783395/
2. Christino MA, Kocher MS. The Paediatric Knee. En: LaPrade RF, Chahla J. Evidence Based Management of Complex Knee Injuries. Philadelphia: Elsevier; 2021. p.396-415.
3. Young EY, Shlykov MA, Hosseinzadeh P, Abzug JM, Baldwin KD, Milbrandt TA. Fractures around the knee in Children. Instr Course Lect [Internet]. 2019 [citado 30 May 2022];68: [aproximadamente 9 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32032063/
4. Andras L, Smith BG. Fractures of the distal femoral physis. En: Waters PM, Skaggs DL, Flynn JM. Rockwood and Wilkin's Fractures in Children. 9ed. Philadelphia: Wolters Kluwer; 2020. p.1375-1416.
5. Cruz AI Jr, Richmond CG, Tompkins MA, Heyer A, Shea KG, Beck JJ. What's new in pediatric sports conditions of the knee? J Ped Orthop [Internet]. 2018 Feb [citado 30 Mayo 2022]; 38(2):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29189538/
6. Bailey MEA, Wei R, Bolton S, Richards RH. Paediatric injuries around the knee: Bony injuries. Injury [Internet]. 2020 Mar [citado 30 Mayo 2022]; 51(3): [aproximadamente 8 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32067766/
7. Pennock AT, Ellis HB, Willimon SC, Wyatt C, Broida SE, Dennis MM, et al. Intra-articular physeal fractures of the distal femur: a frequently missed diagnosis in adolescent athletes. Orthop J Sports Med [Internet]. 2017 Oct [citado 30 Mayo 2022]; 5(10):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29051906/
8. Levene R, Fein DM, Grossman JP. Knee trauma. Ped Rev [Internet]. 2022 Jan [citado 30 Mayo 2022]; 43(1): [aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35229128/
9. Samet JD. Pediatric sports injuries. Clin Sports Med [Internet]. 2021 Oct [citado 30 Mayo 2022]; 40(4):[aproximadamente 18 p.]. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0278-5919(21)00051-X
10. Young EY, Stans AA. Distal femoral physeal fractures. J Knee Surg [Internet]. 2018 Jul [citado 30 Mayo 2022]; 31(6):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29490406/
11. Diallo M, Soulama M, Sidibé A, Ouédraogo S, Dakouré PWH. Reduction of neglected displaced fractures of the distal femoral physis. JBJS Essent Surg Tech [Internet]. 2021 Mar [citado 30 May 2022]; 11(1):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34123549/
12. Sawyer JR, Spence DD. Fractures and dislocations in children. En: Azar FM, Beaty JH. Campbell's Operative Orthopaedics. 14ed. Philadelphia: Elsevier; 2021. p.1593-6.
13. Wilkins KE. Fracturas extra-articulares de la rodilla. En: Pablos J, Gónzalez Herranz P. Apuntes de Fracturas Infantiles. Madrid: Ergon; 1999. p.293-301.
14. Kowalczyk AD, Geminiani ET, Dahlberg BW, Micheli LJ, Sugimoto D. Pediatric and adolescent figure skating injuries: a 15-year retrospective review. Clin J Sport Med [Internet]. 2021 Mayo [citado 30 Mayo 2022]; 31(3):[aproximadamente 14 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30985309/
15. Razzi M, Nordin A. A rare case of non-contact Salter Harris type 2 fracture of distal femur during a football match. Med J Malaysia [Internet]. 2018 Oct [citado 30 May 2022]; 73(5): [aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30350822/
16. Adams AJ, Mahmoud MAH, Wells L, Flynn JM, Arkader A. Physeal fractures of the distal femur: does a lower threshold for surgery lead to better outcomes? J Ped Orthop B [Internet]. 2020 Jan [citado 30 May 2022]; 29(1):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31425335/
17. Woernle M, Fechisin JP. The Pediatric Knee and proximal tibia. Ped Clin N Am [Internet]. 2020 [citado 30 Mayo 2022]; 67:[aproximadamente 14 p.]. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0031395519301373
18. Behera P, Gopinathan NR, Kumar A, Saibaba B, Sudesh P, John R. Distal femoral physeal crush injury with metaphyseal comminution-a report of two cases and a new perspective to physeal injury. Chin J Traumatol [Internet]. 2017 Dec [citado 30 Mayo 2022]; 20(6): [aproximadamente 3 p.]. Disponible en:
https://pubmed.ncbi.nlm.nih.gov/29203221/
19. Rickert KD, Hosseinzadeh P, Edmonds EW. What's new in pediatric orthopaedic trauma: the lower extremity. J Ped Orthop [Internet]. 2018 Sep [citado 30 May 2022]; 38(8):[aproximadamente 5 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29975292/
20. Bellamy JT, Ward LA, Fletcher ND. Evaluation of pediatric distal femoral physeal fractures and the factors impacting poor outcome requiring further corrective surgery. J Ped Orthop B [Internet]. 2021 Jan [citado 30 Mayo 2022]; 30(1):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32317562/
21. MacDonald J, Rodenberg R, Sweeney E. Acute knee injuries in children and adolescents: a review. JAMA Ped [Internet]. 2021 Jun [citado 30 Mayo 2022]; 175(6):[aproximadamente 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33749718/
22. Othman Y, Hassini L, Fekih A, Aloui I, Abid A. Uncommon floating knee in a teenager: a case report of ipsilateral physeal fractures in distal femur and proximal tibia. J Orthop Case Rep [Internet]. 2017 May-Jun [citado 30 Mayo 2022]; 7(3):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29051887/
23. Lorenzen MM, Birkelund L, Laursen JO. Severely dislocated distal physeal femur fracture in a 13-year-old girl. Ugeskr Laeger [Internet]. 2019 Jun [citado 30 Mayo 2022]; 181(24):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31267954/
24. Franklin CC, Skaggs DL, Weiss J. Physeal Fractures About the Knee. En: Scott WN. Insall & Scott Surgery of the Knee. 6 ed. Philadelphia: Elsevier; 2018. p.1281-3.
25. Tuca M, Pineda T. Lesiones traumáticas de rodilla en niños y adolescentes. Rev Med Clín Condes [Internet]. 2021 [citado 30 Mayo 2022]; 32(3):[aproximadamente 10 p.]. Disponible en: https://reader.elsevier.com/reader/sd/pii/S0716864021000493?token=C2E31F930642E668279523E9345401444F4EE23F821068CAADA66C974C774EAE2DE5117A2067CE7BFF4368BDE66226D4&originRegion=us-east-1&originCreation=20220331204401
26. Ozturk M, Yurtbay A, Keskin D, Polat AV, Selcuk MB. Subperiosteal hemorrhage due to a distal femoral physeal fracture in a neonate. North Clin Istanb [Internet]. 2018 Aug [citado 30 Mayo 2022]; 6(3):[aproximadamente 2 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31650122/
27. Ramo B, Ellis HB. Lower Extremity Injuries. En: Herring JA. Tachdjian's Pediatric Orthopaedics. 6ed. Philadelphia: Elsevier; 2022. p.1332-1344.
28. Bonnevie F, Allington N. Growth arrest after a physeal femur fracture in a child. Rev Med Liege [Internet]. 2021 Oct [citado 30 Mayo 2022]; 76(10):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34632737/
29. Conchin A, Ferrara MA, Kaux JF. Stress fracture of the distal femoral growth plate in a young Belgian table tennis champion. Rev Med Liege [Internet]. 2020 Jul [citado 30 Mayo 2022]; 75(7-8):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32779897/
30. Wu X, Xia J, Li J, Sun J, Shen X. Distal femoral physeal fractures after neonatal osteomyelitis: A case report. Medicine (Baltimore) [Internet]. 2019 Mayo [citado 30 May 2022]; 98(18):[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31045792/
31. Gibly RF, Georgopoulos G, Carry PM, Miller NH. Lower extremity physeal fractures and post-traumatic surgical deformities; National Trauma Data Bank and institutional cohorts. J Clin Orthop Trauma [Internet]. 2022 Mar [citado 30 Mayo 2022]; 27:[aproximadamente 3 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35310787/
32. Sabharwal S, Sabharwal S. Growth plate injuries of the lower extremity: case examples and lessons learned. Indian J Orthop [Internet]. 2018 Sep-Oct [citado 30 Mayo 2022]; 52(5):[aproximadamente 7 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30237603/
33. Neubauer T. Pediatric injuries of the knee joint. Unfallchirurg [Internet]. 2019 Jan [citado 30 Mayo 2022]; 122(1):[aproximadamente 14 p.]. Disponible en: https://link.springer.com/article/10.1007/s00113-018-0587-3
34. van den Broek M, Oussedik S. Paediatric fractures around the knee. Br J Hosp Med (Lond) [Internet]. 2017 Aug [citado 30 Mayo 2022]; 78(8):[aproximadamente 5 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28783395/
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Published
2022-12-22
How to Cite
1.
Alvarez-López A, Valdebenito-Aceitón V, Soto-Carrasco SR. Fracture of the distal epiphysis of the femur. Rev Inf Cient [Internet]. 2022 Dec. 22 [cited 2025 Apr. 2];101(6):e3952. Available from: https://revinfcientifica.sld.cu/index.php/ric/article/view/3952
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