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Beitragstitel Trampoline knee injury resulting in leg length discrepancy and functional lumbar scoliosis - "Did my leg really stop growing?"
Beitragscode P50
Autoren
  1. Benjamin Kraler Universitäts-Kinderspital beider Basel (UKBB) Vortragender
  2. Patrik Cervenak Vortragender
  3. Birte Schultz
  4. Stefan Dierauer Orthopädie Sonnenhof
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 1 | Kinder
Abstract Introduction
Distal femoral physeal fractures are the third most common growth plate fracture in children after wrist and ankle physeal fractures. Knee injuries can disrupt the distal femoral physis in the growing skeleton. Affected children are unable to bear weight and frequently present with knee swelling. The distal femoral physis is the fastest growing physis contributing to about 70% of femoral length and 40% of overall lower limb length. Fractures involving the distal femoral physis can have a devastating effect on limb length and angular alignment.
We present a case of a 14-year-old girl that presented with leg length discrepancy of 4cm due to a knee hyperextension injury and premature physeal closure 4 years previously. Leg length discrepancy resulted in a functional lumbar scoliosis and was treated by gradual femoral lengthening with an intra-medullary nail.
Case presentation
A 14-year-old girl presented with leg length discrepancy of 4cm with a shortened right leg and functional lumbar scoliosis. A hyperextension injury of the right knee on the trampoline 4 years previously was recalled. At the time of injury she had been unable to bear weight and swelling of the right knee had been noticed. X-ray in another institution had revealed a slightly widened distal femoral physis. Two weeks later knee MRI highlighted massive bone edema adjacent to the distal femoral physis. Weight bearing as tolerated had been recommended without further follow-up.
4 years later leg length discrepancy of 4cm and a closed distal femoral physis on the right side became evident. Because of functional lumbar scoliosis correction of the leg length discrepancy was recommended. The distal femoral and proximal tibial physes on the left side showed little remaining growth and contralateral epiphyseodesis was not advised. Femoral osteotomy and gradual lengthening using a Precise stryde nail were performed. Weight bearing was allowed with crutches. Distraction of 1mm per day was continued until 4cm of lengthening were achieved.
Conclusion
Distal femoral physeal fractures need to be excluded in children with knee injuries unable to bear weight over a prolonged period. Radiographic changes of the distal femoral physis may be subtle. MRI helps to differentiate between ligamentous knee injury and physeal injury. More than 50% of these fracture cause growth disturbance including leg length discrepancy and angular deformity. Follow-up to skeletal maturity is necessary.