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A 12-year-old female is involved in a car collision and suffered the injury demonstrated in Figure A. Subsequent work-up shows this to be an isolated injury. Following surgical fixation to address the injury, what complication would you most expect and what would be the most appropriate treatment?
Avascular necrosis of the medial femoral condyle, prolonged period of nonweightbearing
Knee stiffness, immediate use of a continuous passive motion device
Physeal growth disturbance, close clinical observation
Physeal growth disturbance, contralateral distal femur epiphysiodesis
Physeal growth disturbance, ipsilateral intramedullary limb lengthening
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Figure A and B are images of a 13-year-old male who sustained an injury playing ice hockey. He underwent closed reduction and casting in a rural hospital. The patient and his parents are seeing you in clinic for the first time, 5 weeks after the date injury. Current radiographs of the knee are shown in Figures C and D. What is the most common complication to warn the patient about with this injury and management?
Physeal growth acceleration
Limb angular deformity
An 11-year-old girl sustains the following injury seen in Figure A. Assuming she has complete physeal arrest, which of the following is the closest approximation to the expected limb-length-discrepancy?
A 10-year-old female presents after being struck by a car while riding her bicycle. Her right leg shows significant swelling and deformity around the knee. An injury radiograph is shown in Figure A. Further radiographic work-up confirms the diagnosis of a Salter-Harris II fracture, without any other significant bony injury. The patient is treated definitively with open reduction and internal fixation with lag screws in the metaphysis. While all of the following have been studied with respect to this injury, which of the following is least predictive of the outcome?
The Salter-Harris classification of the injury
Presence or absence of displacement
Violation of the physis by hardware with surgical treatment
Direction of fracture displacement
Presence of an open fracture
An 11-year-old boy underwent surgical intervention for the injury shown in Figure A two years ago. He currently does not complain of knee pain, but the parents have noticed a progressive bow-leg deformity. Physical examination reveals 5 degrees of varus relative to contralateral side. Current radiographs are provided Figure B. Physeal mapping via CT demonstrates a bar involving 25% of the physis. The remainder of the physis is open. Which of the following is the most appropriate management?
Observation with repeat radiographs in 1 year
Lateral opening wedge distal femoral osteotomy
Guided growth with temporary hemiephysiodesis of the lateral distal femoral physis
Physeal bridge resection with polymethylmethacrylate interposition
Distal femoral epiphysiodesis
All of the variables listed are associated with an increased risk of complications with treatment of distal femoral physeal fractures EXCEPT:
Presence of fracture displacement
Direction of fracture displacment
Violation of the physis with surgical hardware
A 13-year-old boy is unable to bear weight after sustaining a twisting injury during football practice. Physical exam shows swelling and tenderness over the distal femur. Radiographs are shown in Figure A. What is the most appropriate treatment?
Hinged knee brace and weight bearing as tolerated
Long leg cast and non-weightbearing
Skeletal traction for three weeks followed by cast immobilization
Closed reduction and percutaneous fixation
Open reduction and internal fixation of the distal femur with plate fixation
A 10-year-old boy presents to the emergency room after injuring his left knee while playing soccer. He localizes the pain to the distal femur, and is unable to bear weight on the affected leg. On physical exam the patient is tender to palpation only directly over the distal femoral physis. He has swelling about the distal thigh, without any signs of knee effusion. An AP and lateral radiograph of the affected knee are shown in Figures A and B. An AP and lateral radiograph of the contralateral knee are shown in Figures C and D. What is the most appropriate treatment?
Hinged knee brace with early motion and weight bearing as tolerated
Cast immobilization with close clinical followup
Closed reduction and percutaneous pinning
Open reduction with pin fixation
Open reduction with plate fixation