Fractures about the knee: growth disturbances and problems of stability at long-term follow-up.
The aim of this study was to collect information about the incidence of leg-length discrepancy, axis deviation and instability resulting from fractures about the knee in childhood. We reviewed 43 patients with a clinical and radiological examination after a mean follow-up period of 13 years. The fractures were divided into four subgroups, each one presenting typical problems. Growth disturbance (shortening and axis deviation) making secondary procedures necessary was seen in 5 out of 14 (36%) distal femoral epiphyseal fractures. Complex instability was observed in 3 out of 7 (43%) proximal tibial epiphyseal fractures. In the tibial spine fractures anatomical reduction often did not prevent moderate cruciate ligament insufficiency; and in the metaphyseal fractures 2 of the 7 cases showed leg-lenghtening. In conclusion, the Salter classification seems to be of little prognostic value at the knee as Type-II fractures are frequently followed by asymmetric growth arrest. Open reduction is not reliable in avoiding this complication. Associated ligament injuries are not rare and deserve more attention.
Buess-Watson
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Clinique de Chirurgie Pédiatrique, Hôpital Cantonal Universitaire, Genève, Switzerland.
Exner
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GU
Illi
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OE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000209:etiology; D007718:Knee Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D007870:Leg Length Inequality / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D011859:Radiography