What is the treatment for a Salter-Harris type 2 fracture of the distal femur?

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Treatment of Salter-Harris Type 2 Fracture of Distal Femur

For Salter-Harris type 2 fractures of the distal femur, surgical management with anatomic reduction and internal fixation is recommended, with consideration for blade-plate fixation in adolescents to prevent misalignment and growth complications. 1

Initial Assessment and Classification

  • Evaluate the degree of displacement on anteroposterior and lateral radiographs
  • Classify based on displacement:
    • Type 1: Less than 2 mm displacement
    • Type 2: More than 2 mm with contact between fragments
    • Type 3: No contact between fragments
  • Further subclassify as A (no metaphyseal comminution) or B (with metaphyseal comminution) 2

Treatment Algorithm

Minimally Displaced Fractures (Type 1: <2 mm)

  • Non-surgical management with cast immobilization
  • Close monitoring required as even minimally displaced fractures have a 29% risk of premature physeal closure 2

Moderately Displaced Fractures (Type 2: 2-4 mm)

  • Closed reduction under general anesthesia
  • Internal fixation with pins or screws that avoid crossing the growth plate
  • For adolescents near skeletal maturity, consider blade-plate fixation that bridges the growth plate 1

Severely Displaced Fractures (Type 3: >4 mm or no contact)

  • Open reduction and internal fixation (ORIF)
  • Removal of any interposed periosteum or soft tissue
  • Anatomic reduction is critical
  • Consider blade-plate fixation in adolescents 1

Special Considerations for Adolescents

  • For adolescents (11-15 years), blade-plate fixation that bridges the entire growth cartilage shows superior outcomes with significantly lower rates of:

    • Frontal plane deformity (0% vs 25% with traditional fixation)
    • Leg length discrepancy >2cm (0% vs 32% with traditional fixation) 1

  • Consider contralateral distal femoral epiphysiodesis when:

    • Bone age is 11-13.5 years in girls
    • Bone age is 13-14.5 years in boys
    • Predicted leg length discrepancy >2cm 1

Post-Reduction Management

  • Non-weight bearing immobilization for 3-4 weeks
  • Clinical and radiographic reassessment at 2-3 weeks to evaluate fracture healing
  • Progressive range of motion exercises after immobilization period
  • Strengthening exercises for quadriceps and hamstrings

Complications and Follow-up

  • Long-term follow-up is essential due to high complication rates:

    • Overall complication rate of 70% in distal femoral SH II fractures 2
    • Premature physeal closure in 43-55% of cases 3, 2
    • Higher risk with type B fractures (metaphyseal comminution) 2
    • Angular deformities (genu valgum or varum)
    • Leg length discrepancy

  • Monitor for growth disturbances for at least 6-12 months

  • Consider CT imaging if premature physeal closure is suspected

Important Caveats

  • Distal femoral physeal fractures have a worse prognosis compared to other physeal injuries
  • Type 3 fractures (no contact between fragments) have the highest complication rate (100%) 2
  • Metaphyseal comminution (type B) significantly increases risk of growth arrest 2
  • Even with optimal treatment, growth complications may still occur
  • Anatomic reduction does not guarantee prevention of premature physeal closure 3
  • Surgical fixation with blade-plate technique in adolescents shows promising results in preventing misalignment and leg length discrepancy 1

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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