Review Question - QID 1086

All of the variables listed are associated with an increased risk of complications with treatment of distal femoral physeal fractures, EXCEPT for direction of fracture displacement.

Distal femoral physeal fractures are associated with a high incidence of complications including physeal arrest, growth disturbance, and deformity. Several studies have looked at risk factors for complications associated with treatment.

Arkader et al showed that SH classification, presence (but not degree) of fracture displacement, surgical treatment, and violation of the physis with hardware were all associated with an increased incidence of complications. They found the amount and direction of displacement did not correlate with the the incidence of complications (Answer 3).

Lombardo et al reviewed 34 distal femoral physeal fractures and found limb-length discrepancy occurred in 36% and varus or valgus deformity occurred in 33%. They found the development of deformity appears to be related to the degree of initial displacement of the fracture, the exactness of the reduction, and the type of fracture.

Thomson et al reported a retrospective analysis of 30 distal femoral epiphyseal plate fractures. They showed the best results occurred when fractures were anatomically reduced and fixed with pins. The radiograph in Illustration A shows a Salter-Harris II fracture with displacement.