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Physeal, Epiphyseal, and Intra-articular Fractures of the Distal Femur

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Pediatric Femur Fractures

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Abstract

Distal femur fractures in children include physeal fractures (Salter-Harris I–IV) and isolated epiphyseal fractures, which are intra-articular knee injuries occurring most commonly in association with lateral patellar dislocations. Adolescents and preadolescents sustain both categories of distal femur fractures more commonly than younger children.

Distal femoral fractures generally involve high-energy mechanisms of injury, such as motor vehicle accidents and sports injuries. A common mechanism is a direct varus blow or direct valgus blow to the knee, with the foot planted. Alternatively, osteochondral shear injuries to the lateral aspect of the lateral femoral condyle are caused by lateral patellar dislocations, stemming from twisting injuries to the knee.

A thorough neurovascular exam of the affected limb and meticulous secondary survey should be performed for all suspected distal femoral fractures, as concomitant injuries are common. Plain AP and lateral radiographs of the femur and the knee are generally diagnostic, though MRI or CT scan may be necessary to identify intra-articular osteochondral fragments or Salter-Harris III and IV fractures.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Benton E. Heyworth MD, Michael P. Glotzbecker MD & Dennis E. Kramer MD

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  1. Benton E. Heyworth MD
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  2. Michael P. Glotzbecker MD
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  3. Dennis E. Kramer MD
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Correspondence to Dennis E. Kramer MD .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Daniel J. Hedequist

  2. Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Benton E. Heyworth

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Heyworth, B.E., Glotzbecker, M.P., Kramer, D.E. (2016). Physeal, Epiphyseal, and Intra-articular Fractures of the Distal Femur. In: Hedequist, D., Heyworth, B. (eds) Pediatric Femur Fractures. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7986-5_12

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  • DOI: https://doi.org/10.1007/978-1-4899-7986-5_12

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