Distal femoral fractures in children

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Abstract

The physis of the distal femur contributes to 70% of femoral growth and 37% of the total limb growth; therefore, physeal injury can lead to important alterations of axes and length.
Distal metaphyseal corner-type fracture prior to walking is classically associated with child abuse. In children aged >10 years, sports-related fractures and car accidents are significant contributors.
Imaging includes a two-plane radiographic study of the knee. It is recommended to obtain radiographs that include the entire femur to rule out concomitant injuries. In cases of high suspicion of distal metaphyseal fractures and no radiographic evidence, CT or MRI can show the existence of hidden fractures.
Fractures with physeal involvement are conventionally classified according to the Salter–Harris classification, but the Peterson classification is also recommended as it includes special subgroups.
Conservative and surgical management are valid alternatives for the treatment of these fractures. Choosing between both alternatives depends on factors related to the fracture type.
As there is a high risk of permanent physeal damage, long-term follow-up is essential until skeletal maturity is complete.

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Injuries Involving the Epiphyseal Plate

ROBERT SALTER, W. ROBERT HARRIS (1963)

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Epidemiology and mechanisms of femur fractures in children.

Randall Loder, Patrick W O'Donnell, Judy R Feinberg (2015)

The most common pediatric orthopaedic injury requiring hospitalization is a femur fracture. This study aimed to identify the epidemiology and mechanisms of injury so that these injuries might be reduced through specifically targeted safety measures. Data for this study were culled from the 2000 Kids' Inpatient Database representing over 2.5 million pediatric hospital discharges. Of the nearly 10,000 femur fractures, 1076 (11%) occurred in children younger than 2 years; 2119 (21%) in children aged 2 to 5 years; 3237 (33%) in children aged 6 to 12 years; and 3528 (35%) in adolescents aged 13 to 18 years. The most (71%) occurred in male patients. Falls and motor vehicle collisions accounted for two thirds of those injuries, with the incidence of falls greater in the younger children and motor vehicle collisions more prevalent in older children. Fifteen percent of femoral fractures in children younger than 2 years were because of child abuse. Length of hospital stay, number of diagnoses and procedures, and hospital charges were greatest in the adolescent age group, likely because of high-energy trauma with resultant polytrauma. Hospital charges were more than 222 million dollars with the average charge over 2.5 times that in adolescents compared with infants/toddlers. Pediatric orthopaedists must continue to press for increased safety for our children, particularly adolescent motor vehicle safety. Abuse should be considered when a child younger than 2 years presents with a femoral fracture.