Separation of Distal Femoral Epiphysis

This is a common epiphyseal injury in adolescents that can occur in the anterior plane or coronal plane. The anterior separation is usually the result of a hyperextension injury. The more common coronal separation is a result of abduction and adduction forces, most often occurring during sports activities or play. The patient complains of acute injury with inability to bear weight with displaced fractures and presents with a flexion deformity. As with most epiphyseal injuries, the examiner finds circumferential tenderness around the entire epiphyseal plate, and effusion and swelling are typically present. The standard radiographic views for evaluating the knee are required. The Salter-Harris classification is used to classify these fractures, with type II being the most common. Stress films may be necessary to diagnose Salter-Harris I injuries. The treatment of nondisplaced fractures is above the knee cast immobilization with the knee in 20° of flexion for four to six weeks. Displaced Salter-Harris I or II fractures require reduction with gentle traction followed by cast immobilization. Displaced Salter-Harris III and IV fractures typically require open reduction and internal fixation. The prognosis of these fractures is generally good, with return to normal activities expected within four to six months. Complications include popliteal artery injury with markedly displaced fractures and peroneal nerve injury. 28

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