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Distal Femur Physeal Fracture

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Distal Femur Physeal Fracture, Epiphyseal Fracture of the Distal Femur, Distal Femur Fracture in Children

  • See Also
  1. Knee Injury
  2. Epiphyseal Fracture
  3. Musculoskeletal Trauma
  • Epidemiology
  1. Incidence: 1% of Pediatric Fractures
  • Mechanism
  1. Knee hyperextension injury is most common mechanism
    1. Physis is weaker than the surrounding ligaments
  2. Valgus or varus stress may also have been present
  • Findings
  1. Acute Knee Pain and tenderness over the distal femur
  2. Local swelling
  3. Knee Deformity
  4. Limited range of motion due to pain
  5. Non-ambulatory
  • Exam
  1. See Knee Exam
  2. Distal Neurovascular Exam
  3. Examine the proximal and distal joints, as well as the contralateral side
    1. Associated injuries may be missed due to distracting injury
    2. See Secondary Trauma Evaluation
  • Imaging
  1. Knee XRay (AP and Lateral)
    1. Salter Harris 2 Fracture is most common Distal Femur Physeal Fracture
    2. Initial XRay may be negative for physeal Fracture
      1. Consider non-weight bearing and Splinting if high index of suspicion
      2. Repeat XRay in 5 days
  2. MRI (or CT)
    1. Consider in non-diagnostic XRay on serial imaging
  • Differential Diagnosis
  1. See Knee Injury
  • Management
  1. Serial neurovascular exams
  2. Analgesia
    1. See Pediatric Analgesic
  3. Immobilization (with Crutches for non-weight bearing)
    1. Long Leg Posterior Splint OR
    2. Knee Immobilizer
  4. Initial Closed Reduction Indications (Emergency Department)
    1. Neurovascular compromise
    2. Severe deformities
  5. Orthopedic Consultation
    1. ORIF often needed in Salter 2 and worse Fractures to prevent growth problems
  6. Monitoring
    1. Continued monitoring of healing and growth for at least 6-12 months
    2. Ideally observe until skeletal maturity
  • Complications
  1. Common
    1. Premature epiphyseal closure (physeal growth arrest, 58% of cases)
    2. Angular deformity
    3. Limb Length Discrepancy >1.5 cm (22% of cases)
  2. Other complications
    1. Vascular injury
    2. Knee ligament laxity
    3. Compartment Syndrome
  • Prognosis
  1. High risk for growth complications
  • Resources
  1. Distal Femoral Physeal Fractures - Pediatric (OrthoBullets)
    1. https://www.orthobullets.com/pediatrics/4020/distal-femoral-physeal-fractures--pediatric
  2. Distal Femur Fractures (POSNA)
    1. https://posna.org/physician-education/study-guide/distal-femur-fractures
  • References
  1. Thokalath (2025) Crit Dec Emerg Med 39(12): 22-3
  2. Sepúlveda (2022) EFORT Open Rev 7(4):264-73 +PMID: 37931413 [PubMed]