title: Apophyseal and epiphyseal knee injuries in the adolescent athlete.
abstract: OBJECTIVE
  In the context of pediatric sports injuries, the epiphyseal and apophyseal knee fractures represent rather peculiar lesions. The most frequently involved anatomical area is the knee. The peculiar function of the physis and the need to preserve their integrity, makes choosing what treatment methods to employ very important. Objective of this study is to assess the kind and the effectiveness of the most suitable treatment in the apophyseal and epiphyseal knee lesions occurring in the adolescents.
  
  
  METHODS
  From 2006 to 2011, were treated 41 patients (34 M-7 F) between the ages of 10 and 15, with a diagnosis of traumatic knee injury caused by sports activities. Traumatic physeal fractures of the distal femur, the proximal tibia and its anterior tuberosity and the avulsion of the intercondylar eminence were the lesions that occurred most frequently. The treatment belonged to the type of lesion: closed reduction or percutaneous fixation with K-wires/ screws and a femoral-podalic plaster cast, ORIF with K-wires/screws, arthroscopic reduction and internal fixation using absorbable screws. All the patients were given the POSNA questionnaire at the end of the follow up.
  
  
  RESULTS
  The follow up was on average 5 years (4-10 years). We considered as excellent the results obtained in 26 patients, as fair in 12 patients, in 1 case the result obtained was considered as poor. 2 caseswere lost during follow up. The average POSNA score at the end of the follow-up was 98.51. Any early complications recorded were the following: in 1 case infection of the K-wires 32 days after pinning and a reported compression of the popliteal neurovascular bundle, due to a displaced tibial physeal fracture.
  
  
  CONCLUSIONS
  Since sport during childhood and adolescence is now practiced more and more frequently, also at a competitive level, thesekinds of fractures in children between the ages of 10 and 15 have been occurring more often, especially in male patients. Sports traumatology of the knee in this age group is characterized by a typology of injuries that are very particular. The knowledge of the anatomy and physiology of children, with an appropriate diagnostic assessment, is essential to identify the most appropriate treatment options for each specific injury. As the nucleus of proximal tibial growth plate progressively closes from posterior to medial side, in patients between 11 and 13 years of age with an apophyseal displacement of the tibial tuberosity, you should always perform a CT exam, to exclude an intra-articular physeal fracture.
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences - Sapienza University of Rome.
authors.forename: P
authors.initials: P
authors.lastname: Persiani
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences - Sapienza University of Rome.
authors.forename: F M
authors.initials: FM
authors.lastname: Ranaldi
authors.affiliation: San Giovanni Addolorata Hospital - Rome.
authors.forename: A
authors.initials: A
authors.lastname: Formica
authors.affiliation: IRCCS Bambino Gesù Pediatric Hospital- Palidoro (Roma).
authors.forename: M
authors.initials: M
authors.lastname: Mariani
authors.affiliation: IRCCS Bambino Gesù Pediatric Hospital- Palidoro (Roma).
authors.forename: O
authors.initials: O
authors.lastname: Mazza
authors.affiliation: IRCCS Bambino Gesù Pediatric Hospital- Palidoro (Roma).
authors.forename: M
authors.initials: M
authors.lastname: Crostelli
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences - Sapienza University of Rome.
authors.forename: C
authors.initials: C
authors.lastname: Villani
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000601:surgery*; D001864:Bone Wires; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D016059:Range of Motion, Articular; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Adolescence; Fracture; Injury; Knee; Physis; Sport