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Hinged knee brace and weight bearing as tolerated
0%
6/3684
Long leg cast and non-weightbearing
1%
50/3684
Skeletal traction for three weeks followed by cast immobilization
4/3684
Closed reduction and percutaneous fixation
79%
2925/3684
Open reduction and internal fixation of the distal femur with plate fixation
18%
675/3684
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The history, physical exam, and radiographs are consistent with a displaced Salter-Harris II fracture of the distal femoral physis. Because the fracture is displaced, closed reduction with percutaneous pinning would be the most appropriate treatment. Open reduction and internal fixation is reserved for SHIII and SHIV fractures and irreducible displaced SH I or II fractures. If anatomic reduction cannot be obtained via closed techniques, incision over the displaced physis to remove interposed periosteum is necessary. The first referenced article by Graham et al showed a 70% displacement rate with cast treatment of these injuries, and a 90% growth disturbance rate when treated in a closed fashion. They note that initial anatomic reduction with rigid fixation of physeal injuries about the ankle has been demonstrated to decrease the incidence of growth deformity. The second referenced article by Riseborough et al described the commonly noted growth disturbances of the distal femoral physis when injured, and reported a 56% rate of leg length discrepancy (>2.4cm) with this injury pattern. The last referenced article by Thomson et al showed no displacement with closed reduction and percutaneous fixation of this injury compared to 43% displacement with long leg casting. They also report that complications were more frequent in displaced than nondisplaced fractures.
4.2
(28)
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