Operative treatment of fractures about the knee.

It should be emphasized that most fractures about the knee in children and adolescents can be treated by closed methods. It follows that open reduction and fixation is employed when closed reduction fails. An interposed flap of torn periosteum may prevent closed reduction. Internal fixation is often required in avulsion fractures of the tibial tubercle, reduced displaced fracture-separations of the proximal tibial epiphysis, fracture-separations of the distal femoral epiphysis displaced in the sagittal plane, and displaced Salter-Harris type III and IV fracture-separations. A displaced avulsion of the anterior intercondylar eminence of the tibia can sometimes be reduced using closed means but more often requires reduction by arthrotomy or with arthroscopy. Late reconstruction for ensuing leg length discrepancy, angular deformity, or instability may be indicated.