Nonunion of a distal femoral epiphyseal fracture-separation.

Distal femoral physeal fractures account for approximately 1% of all epiphyseal injuries. Complications include growth arrest and leg length discrepancy, malunion and deformity, and stiffness and knee instability. However, nonunion of such a fracture is exceedingly rare and has only been reported in patients with spinal dysraphism. We report a case of distal femoral physeal nonunion in a neurologically intact adolescent athlete. Initially, there was a delay in the diagnosis of this nondisplaced fracture, as the patient had normal roentgenograms. Additional imaging modalities (magnetic resonance imaging, stress radiographs) should be performed if there is a high index of suspicion of physeal injury when roentgenograms are normal.