Distal Femoral Physeal Injuries



1.  Undulating growth plate / higher rate of growth plate injury

- growth arrest / LLD

- angular deformity

- need to be warned

- require close and careful follow up especially in first 2 years


2.  Can be unstable / malunion and shortening very problematic in this area




Salter Harris I


Distal Femoral Fracture SH2 APDistal Femoral Fracture SH2 Lateral


Salter Harris II


SH2 Distal Femoral Fracture APSH2 Distal Femoral Fracture Lateral






Extension plaster 6 weeks






Low threshold to ORIF to maintain position

- already have high risk of growth arrest / LLD / angular deformity

- don't wish to deal with malunion / loss of position as well




Block to reduction

- often medial sided periosteum

- may need small medial subvastus / anteromedial approach




1.  Physeal sparing metaphyseal screw in SHII

- good option if Thurston-Holland fragment large enough


Distal Femur Salter Harris 2Distal Femur Salter Harris 2


Distal Femur SH2 ORIFDistal Femur SH2 ORIFDistal Femur SH2 Lateral


2.  Smooth transphyseal large K wires / Steinman pin


- SHII with small Thurston-Holland fragment




Complete growth arrest common


Monitor 6 monthly

- plot short and long leg lengths on Mosely chart

- distal femur contributes 9 mm / year


Manage LLD as per predicted difference

- usually contralateral femoral epiphysiodesis if < 5 mm

- may need femoral lengthening / ISKD on maturity if > 5 mm


Partial growth arrest / angular deformity


Moniter closely and investigate any possible growth arrest



- assess percentage of bony bridge


Bony bridge < 50%

- excision and fat graft

- manage angular deformity with 8 plates / osteotomy


Bony bridge > 50%

- hemi-epiphysiodesis

- may need correction of LLD and angular deformity

- opening wedge femoral osteotomy