FRACTURES INVOLVING THE DISTAL FEMORAL EPIPHYSEAL CARTILAGE

¹ Sixth Surgical Service, Boston City Hospital, and the Department of Orthopaedic Surgery, Tufts Medical School, Boston

Fractures involving the distal femoral epiphyseal cartilaginous plate are uncommon injuries. Fifteen eases have been seen at the Boston City Hospital in the past five years out of a total of 5,500 fracture admissions.

Nine patients have been followed from one to eight years. In seven cases all epiphyseal eartilages are now fused. All fractyres were of the avulsion type. Displacement occurred in any direction.

Most fractures occurred in males between the ages of thirteen and seventeen years. In the older age group all fractures were the result of football accidents, and all were seen in the autumn months.

In only two cases was anatomical position maintained. Attention is called to the role played by the medial head of the gastrocnemius in fractures with posterolateral displacement. Such fractures must be immobilized with the joint in extension in contradistinction to supracondylar fractures which appear to be similar but require immobilization of the joint in flexion for the maintenance of reduction.

Deformity did not develop in any patient.

Shortening due either to premature ossification or retardation of growth or both is not uncommon but only on occasion is it of clinical significance. In this series, shortening occurred in three patients; in only one, however, was it of potential clinical importance.

The knee joint showed slight loss of flexion in four patients; slight hyperextension was present in three patients; and an unexplained relaxation of the anterior cruciate ligament occurred in four patients.

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