Pennock Andrew T, Ellis Henry B, Willimon Samuel C, Wyatt Charles, Broida Samuel E, Dennis M Morgan, Bastrom Tracey
Rady Children's Hospital, San Diego, California, USA.
Sports Medicine Center, Texas Scottish Rite Hospital, Dallas, Texas, USA.
Orthop J Sports Med. 2017 Oct 10;5(10):2325967117731567. doi: 10.1177/2325967117731567. eCollection 2017 Oct.
Intra-articular physeal fractures of the distal femur are an uncommon injury pattern, with only a few small case series reported in the literature.
To pool patients from 3 high-volume pediatric centers to better understand this injury pattern, to determine outcomes of surgical treatment, and to assess risk factors for complications.
Case series; Level of evidence, 4.
A multicenter retrospective review of all patients presenting with an intra-articular physeal fracture between 2006 and 2016 was performed. Patient demographic and injury data, surgical data, and postoperative outcomes were documented. Radiographs were evaluated for fracture classification (Salter-Harris), location, and displacement. Differences between patients with and without complications were compared by use of analysis of variance or chi-square tests.
A total of 49 patients, with a mean age of 13.5 years (range, 7-17 years), met the inclusion criteria. The majority of fractures were Salter-Harris type III fractures (84%) involving the medial femoral condyle (88%). Football was responsible for 50% of the injuries. The initial diagnosis was missed in 39% of cases, and advanced imaging showed greater mean displacement (6 mm) compared with radiographs (3 mm). All patients underwent surgery and returned to sport with "good to excellent" results after 2 years. Complications were more common in patients with wide-open growth plates, patients with fractures involving the lateral femoral condyle, and patients who were casted ( < .05).
Clinicians evaluating skeletally immature athletes (particularly football players) with acute knee injuries should maintain a high index of suspicion for an intra-articular physeal fracture. These fractures are frequently missed, and advanced imaging may be required to establish the diagnosis. Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with high rates of return to sport.
股骨远端关节内骨骺骨折是一种不常见的损伤类型，文献中仅有少数小样本病例系列报道。
汇总来自3家大型儿科中心的患者，以更好地了解这种损伤类型，确定手术治疗的结果，并评估并发症的危险因素。
病例系列；证据等级，4级。
对2006年至2016年间所有出现关节内骨骺骨折的患者进行多中心回顾性研究。记录患者的人口统计学和损伤数据、手术数据及术后结果。对X线片进行骨折分类（Salter-Harris分型）、位置及移位情况评估。采用方差分析或卡方检验比较有并发症和无并发症患者之间的差异。
共有49例患者符合纳入标准，平均年龄13.5岁（范围7 - 17岁）。大多数骨折为Salter-Harris III型骨折（84%），累及股骨内侧髁（88%）。50%的损伤由足球运动导致。39%的病例初诊时漏诊，与X线片相比（3 mm），高级影像学检查显示平均移位更大（6 mm）。所有患者均接受手术治疗，2年后恢复运动，结果为“良好至优秀”。并发症在生长板完全开放的患者、累及股骨外侧髁的骨折患者以及采用石膏固定的患者中更为常见（P <.05）。
评估骨骼未成熟运动员（尤其是足球运动员）急性膝关节损伤的临床医生应高度怀疑关节内骨骺骨折。这些骨折常被漏诊，可能需要高级影像学检查来确诊。腿长差异和角畸形并不少见，应密切监测患者。骨折确诊后手术效果良好，恢复运动的比例较高。
