Growth disturbances following distal femoral physeal fracture-separations.

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Abstract
The results were studied following 66 distal femoral physeal fracture-separations. Of those who were referred secondarily, many already had growth problems and the complications listed, while accurate, are not necessarily a true reflection of the frequency following such fracturs. Lower-extremity length discrepancies in exess of 2.4 cm or leading to contralateral distal femoral physeal arrest occurred in 37 patients (56%), and angular deformity of more than 5.degree. or requiring osteotomy occurred in 17 patients (26%). The radiographic sign of central arrest occurred in 13 patients (20%) and was associated primarily with type-I and type-II injuries. This sign had excellent predictive value for the development of limb-length discrepancy. Growth problems correlated well with the severity of trauma and were seen in each of the Salter-Harris types. Fractures in the juvenile age group (2-11 yr old) were almost invariably caused by severe trauma and had the poorest prognosis; 19 (83%) of the 23 injuries in juvenile patients resulted in growth problems. Fractures in the adolescent age group (11 yr old and older) were caused by less extensive trauma, being associated most often with sports injuries; 18 (50%) of the 36 adolescents had growth problems. Birth fractures and those in the 1st 2 yr of life were associated with mild growth disturbances on occasion but did not lead to severe growth problems in any of the seven patients. The final results apparently would be improved by anatomical reduction and greater use of internal fixation in type-II, III and IV injuries. The management of these patients after healing of the fracture was not sufficiently aggressive, as 19 patients had a length discrepancy of 2.4 cm or more persisting at skeletal maturity.

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