Distal femoral fractures in children
- Kimberly P Stone, MD, MS, MA
Kimberly P Stone, MD, MS, MA
- Associate Professor of Pediatrics
- University of Washington
- Klane White, MD
Klane White, MD
- Associate Professor, Department of Orthopaedics and Sports Medicine
- University of Washington School of Medicine
- Section Editor
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Distal femur fractures in pediatrics patients are discussed here. Hip fractures and femoral shaft fractures in children are discussed separately. (See "Hip fractures in children" and "Femoral shaft fractures in children".)
Distal femur fractures can be classified as metaphyseal fractures or physeal fractures.
Metaphyseal fractures — Transverse distal metaphyseal fractures (also called supracondylar femoral fractures) are the most common type of distal femur fracture in infants and young children (image 1) .
Physeal fractures — Distal physeal femur fractures occur more commonly in older children and adolescents. The Salter-Harris classification of physeal fractures is most often used (figure 1).
●Salter-Harris type I – Salter-Harris type I fractures were thought to be an uncommon type of distal pediatric femur fracture in early studies, accounting for only about 7 percent of distal femur physeal fractures . However, more recent studies suggest an incidence of between 21 to 25 percent [3-5]. Salter-Harris Type I fractures occur in vaginally delivered breech newborns, abused infants, and as a sports related injury in adolescents [6,7]. When there is no fracture displacement, initial plain radiographs may be negative which can make these injuries difficult to diagnose. (See 'Imaging' below.)
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- Metaphyseal fractures
- Physeal fractures
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- CLINICAL FEATURES AND EXAMINATION
- Plain radiographs
- Other imaging
- INITIAL TREATMENT
- Child protection
- INDICATIONS FOR ORTHOPEDIC CONSULT OR REFERRAL
- DEFINITIVE CARE
- FOLLOW-UP CARE
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS