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A prospective, consecutive series of distal femoral growth
plate injuries: a phenomena of the developing world Abstract: Fractures of the distal femoral growth plate (DFGP) are rare with only three retrospective series reported in the literature, all from developed countries, reporting a high-energy mechanism for this injury. In contrast, we report the first large prospective series, where the majority of patients have a low-energy injury. Consecutive patients presenting with a DFGP injury were entered into the study. There were no exclusion criteria. There were 42 patients recruited to the study (38 male) with and average age of 15.9 years. 24/42 (57%) DFGP injuries occurred whilst playing football, and only 12 (28% resulted from a high-energy injury. 34 (81%) had a Salter 1 or II fracture and 8 (19%) had a Salter III-V fracture. 8 (19%) required manipulation and casting alone, 34 (79%) required internal fixation (with 8 (19%) requiring percutaneous wires and 23 (55%) requiring screw fixation and 2 (5%) requiring plate fixation). Mean follow up is 5.3 months. The outcome in terms of mean range of movement is 80 degrees of flexion. The DFGP injury in developing countries appears to be associated with low energy injuries in contrast to reports from the developed world. Physical closure occurs at a later in developing world populations, allowing a putative explanation for this phenomenon: the combination of increased body weight (in late teen age years), long lever arms and open physes makes the DFGP a vulnerable area. In conclusion, the first prospective series in the world literature and the first series in a developing world population. |
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