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Femoral Physeal Frx: Growth Plate Arrest


- Discussion:
    - physeal bone bridges
    - methods to estimate growth potential
    - anatomy of distal femoral physis
    - distal femoral physis grows roughly at a rate of 9 mm/year (girls finish growing at age 14) 
    - growth arrest, partial or complete, w/ progressive angulation &/or shortening ranges from 30% & 80% of pts;
          - shortening & angulation are more related to degree of initial displacement rather than accuracy of the reduction;
    - leg length discrepancy of > 2 cm may develop in 1/3 of pts;
    - incidence of growth arrest is high, even with satisfactory reduction;
    - angulation more than 5 deg may also develop in 1/3 of pts;
          - persistent angular deformity in coronal plane may not correct spontaneously with further growth;

- SH II:
    - if asymmetrical growth inhibition follows type II separation, portion of grwth plate underneath metaphyseal fx is spared;
    - if metaphyseal frag is medial, valgus deformity may ensue;
    - if metaphyseal frag is lateral, varus angulation may ensue;

- SH III:
    - look for vertical fracture line originating from the notch;
    - reduction may be unstable and require internal fixation



Growth disturbances following distal femoral physeal fracture-separations.

Physeal arrest about the knee associated with non-physeal fractures in the lower extremity.

Predicting the Outcome of Physeal Fractures of the Distal Femur.   
              
Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis.

The effect of percutaneous pin fixation in the treatment of distal femoral physeal fractures