Anteroposterior x-ray of a 15-year old boy following a skateboarding injury shows displaced Salter-Harris type II distal femur fracture
Lateral x-ray of the patient’s femur fracture
A 15-year-old boy presents to the emergency department with severe right leg pain after a skateboarding injury. X-ray shows displaced Salter-Harris type II distal femur fracture.
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A Salter-Harris type II fracture is the most common type of pediatric distal femur physeal fracture. The treatment of choice for this type of fracture is closed reduction and percutaneous screw or pin fixation.
Rigid plate fixation may be considered in those nearing skeletal maturity, as fixation that crosses the physis will stop any remaining growth. If possible, crossing an open physis with any type of hardware, including screws, pins, or plates, should be avoided to prevent potential growth disturbance. External fixation is reserved for patients with significant soft tissue injury or with severely comminuted fracture.
There is a high incidence of postoperative growth disturbance following physeal injury of the distal femur. Factors that predict the likelihood of growth disturbance include age of the patient (higher in those with significant growth remaining), degree of displacement (higher with >50% displacement of the width of the physis), type of Salter-Harris fracture, and surgical fixation. Multiple attempts at reduction and hardware placement across the physis result in a higher likelihood of growth arrest.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Beaty JH, Kasser JR, eds. Rockwood and Wilkins’ Fractures in Children. 6th ed. Philadelphia PA: Lippincott Williams & Wilkins; 2006.
- Abbasi D. Distal femoral physeal fractures—pediatric. Orthobullets.com. http://www.orthobullets.com/pediatrics/4020/distal-femoral-physeal-fractures–pediatric. Updated December 31, 2015. Accessed February 8, 2016.