FRACTURES AROUND THE DISTAL FEMORAL GROWTH PLATE

Abstract

25 cases of closed fractures around the distal femoral growth plate were analysed prospectively over a one-year period. There were 22 males and 3 females. Mean age was 16 years (range 7 to 22).

According to the classification of Salter and Harris there were 6 cases (24%) of type 1 fracture, 12 (48%) type 2 fractures, 3 (12%) type 3, and 4 (16%) type 4. Mechanism of injury was football in 13 (59%), simple fall in 4 (18%), crush in 2 (9%), RTA in 2 (9%), and fall from height in 1 (5%); in 3, the mechanism was not recorded. The average time from injury to hospital admission was 5 days (range 0 to 17 days).

Management was conservative in 4 and operative in 21. The medial parapatellar approach was used in 16. Post-surgically plaster cylinders were used for a mean of 3 weeks (range 0 to 6 weeks). No patient received physiotherapy.

In the operative cases, sepsis was observed in 1 case (5%). This was a crash injury with a skin ulcer that became septic postoperatively and later required knee fusion.

Of the remaining 20 operative cases, 17 cases were reviewed, 4 to one year, 9 to six months, and 4 to three months. There were no cases of deformity, nor wound complications. Those reviewed at one year had an excellent range of movement averaging 0 to 117 degrees (range 0–100 to 0–140). At six months the average range of movement was 1–98 degrees (range 5–70 to 0–140) and at three months 2–62 degrees (range 10–50 to 0–95).

In conclusion, we believe that these difficult fractures should usually be managed operatively where expertise allows. Preliminary results suggest that the medial parapatellar approach provides excellent access but may inhibit initial rehabilitation.