Distal Femur Physeal Fracture - Everything You Need To Know - Dr. Nabil Ebraheim
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2 سال پیش
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Dr. Ebraheim’s educational animated video
Dr. Ebraheim’s educational animated video describes the condition distal femur physeal fracture in children.
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There is 60% physeal arrest following physeal injuries in the distal femur. The rate is higher in cases where the initial fracture is displaced. If you think of MCL / LCL sprain in the young patient, then consider a growth plate injury of the distal femur. The Thurstan Hollandfragment is a spike of metaphyseal bone in Salter II distal femur fracture. If the metaphyseal fragment is large then fix it with screws across the fracture only (the screws will be parallel to the physis). If there is a small metaphyseal fragment or Salter I fracture, then you will do percutaneous pinning with smooth K - wires.
A 9 years old patient with injury of the knee, tenderness over the medial aspect of the knee and a stress exam will show instability. X-ray does not show any abnormality. In the past, they used to get stress view x-rays but nowadays we do not do this. Now we get an MRI and the treatment will be closed reduction and smooth pin fixation percutaneously and splint the patient. Get MRI or a CT scan for a nondisplaced fracture if there is a clinical suspicion of growth plate injury. The distal femur grows at a rate of 9 mm per year. The epiphysis of the distal femur is the first one to ossify and the last one to fuse. It contributes to 70% of the growth of the femur and 37% of the growth of the lower extremity. Girls finish their growth at the age of 14 years and boys finish their growth at the age of 16 years. Different scenarios for the grow arrest and how it can be handled. If the growth arrest is central, then there is a leg length discrepancy. A 12 years old female patient with a displaced distal femur fracture, the estimated leg length discrepancy is 2 cm if there is a total arrest of the physis of the femur. If the growth arrest is peripheral, then an angular deformity may develop. A young patient with a distal femur fracture involving the growth plate was treated by surgery. The patient has progressive knock knee deformity because the patient developed peripheral growth arrest and if the arrest is less than 50%, then you will do resection of the peripheral bridge with interposition of fat.
Salter - Harris Classification
Salter - Harris classification types for fracture of the distal femur. One must be familiar with these types. Salter II fracture is the most common type of distal femur physeal fracture in children. In Salter II fracture, a portion of the metaphysis stays with the epiphysis. This portion is not injured and will continue to grow normally. The portion of the physis that is separated, for example the medial part, is damaged and may expect growth arrest. In the future, that medial growth arrest will result in varus deformity or genu varum. Salter II fracture of the distal femur is an independant risk factor for need of additional surgery or treatment associated with it. The major zones of the physis begins at the epiphysis.
The zone of hypertrophy is the weakest part of the physis and usually fractures of the physis occur in this zone. However, in distal femur physeal fracture, the fracture propagates through multiple layers of the growth plate and not just the zone of hypertrophy. New bone is generated and the length is added at the metaphyseal side of the physis. A premature growth arrest will affect the metaphyseal part of the bone, not the epiphyseal part of the bone. In this fracture pattern, where does the growth arrest usually occur? It is the medial side (metaphyseal side) of the physis. Which portion of the bone is most likely to stop growing? It is the medial side (metaphyseal side) of the physis if the spike of the metaphysis is on the lateral side. The portion of the metaphysis attached to the physis will continue growing and the patient can get varus deformity later on. Genu valgum occurs if the metaphyseal fragment is medial and the lateral portion of the physis is damaged. The odds of receiving further surgery with a distal femur physeal fracture was 8.3 times more likely for immature children.
Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC
Find me on Instagram @OrthoInitiative
There is 60% physeal arrest following physeal injuries in the distal femur. The rate is higher in cases where the initial fracture is displaced. If you think of MCL / LCL sprain in the young patient, then consider a growth plate injury of the distal femur. The Thurstan Hollandfragment is a spike of metaphyseal bone in Salter II distal femur fracture. If the metaphyseal fragment is large then fix it with screws across the fracture only (the screws will be parallel to the physis). If there is a small metaphyseal fragment or Salter I fracture, then you will do percutaneous pinning with smooth K - wires.
A 9 years old patient with injury of the knee, tenderness over the medial aspect of the knee and a stress exam will show instability. X-ray does not show any abnormality. In the past, they used to get stress view x-rays but nowadays we do not do this. Now we get an MRI and the treatment will be closed reduction and smooth pin fixation percutaneously and splint the patient. Get MRI or a CT scan for a nondisplaced fracture if there is a clinical suspicion of growth plate injury. The distal femur grows at a rate of 9 mm per year. The epiphysis of the distal femur is the first one to ossify and the last one to fuse. It contributes to 70% of the growth of the femur and 37% of the growth of the lower extremity. Girls finish their growth at the age of 14 years and boys finish their growth at the age of 16 years. Different scenarios for the grow arrest and how it can be handled. If the growth arrest is central, then there is a leg length discrepancy. A 12 years old female patient with a displaced distal femur fracture, the estimated leg length discrepancy is 2 cm if there is a total arrest of the physis of the femur. If the growth arrest is peripheral, then an angular deformity may develop. A young patient with a distal femur fracture involving the growth plate was treated by surgery. The patient has progressive knock knee deformity because the patient developed peripheral growth arrest and if the arrest is less than 50%, then you will do resection of the peripheral bridge with interposition of fat.
Salter - Harris Classification
Salter - Harris classification types for fracture of the distal femur. One must be familiar with these types. Salter II fracture is the most common type of distal femur physeal fracture in children. In Salter II fracture, a portion of the metaphysis stays with the epiphysis. This portion is not injured and will continue to grow normally. The portion of the physis that is separated, for example the medial part, is damaged and may expect growth arrest. In the future, that medial growth arrest will result in varus deformity or genu varum. Salter II fracture of the distal femur is an independant risk factor for need of additional surgery or treatment associated with it. The major zones of the physis begins at the epiphysis.
The zone of hypertrophy is the weakest part of the physis and usually fractures of the physis occur in this zone. However, in distal femur physeal fracture, the fracture propagates through multiple layers of the growth plate and not just the zone of hypertrophy. New bone is generated and the length is added at the metaphyseal side of the physis. A premature growth arrest will affect the metaphyseal part of the bone, not the epiphyseal part of the bone. In this fracture pattern, where does the growth arrest usually occur? It is the medial side (metaphyseal side) of the physis. Which portion of the bone is most likely to stop growing? It is the medial side (metaphyseal side) of the physis if the spike of the metaphysis is on the lateral side. The portion of the metaphysis attached to the physis will continue growing and the patient can get varus deformity later on. Genu valgum occurs if the metaphyseal fragment is medial and the lateral portion of the physis is damaged. The odds of receiving further surgery with a distal femur physeal fracture was 8.3 times more likely for immature children.
2 سال پیش
در تاریخ 1401/02/02 منتشر شده
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