Intra-articular Physeal Fracture Often Missed in Young Athletes

In a study, “Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes,” published in the October 2017 issue of the Orthopaedic Journal of Sports Medicine, researchers discovered that clinicians often miss intra-articular physeal fractures when evaluating skeletally immature athletes with acute knee injuries.

In a multicenter retrospective review of patients presenting with an intra-articular physeal fracture between 2006 and 2016 at three high-volume pediatric centers, differences between patients with and without complications were compared.

According to the data, out of 49 patients (mean age 13.5 years), the initial diagnosis was missed in 39% of the patients, and advanced imaging showed a greater mean displacement compared with radiograph (6mm vs 3mm).

All the patients were treated with surgery and were able to return to sport. Patients with wide-open growth plates, as well as those who are casted were more likely to have complications.

The researchers suggested that clinicians when presented with a young athlete with an acute knee injury should be more suspicious of an intra-articular physeal fracture.

They wrote, “Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with higher rates of return to sport.”