Physeal Fractures About the Knee.

The knee is the most common site of injury in childhood sports, and with increased participation in organized sports, the potential for knee injuries has accordingly increased. The epiphyses and apophyses provide a site of injury unique to the immature patient. The distal femoral and proximal tibial physes and the tubercle apophysis respond differently to acute and repetitive load and often provide less resistance to traumatic forces than do surrounding ligament and bone. Treatment of displaced physeal fractures about the knee remains one of the more difficult problems in orthopaedics. Even with appropriate conservative or surgical treatment, a successful outcome is not ensured. The Salter-Harris classification system provides general guidelines regarding the risk of growth disturbance, but there are no clinical methods for quantifying the true extent of physeal damage in an acute injury. Ultimately, the value of a treatment method must be evaluated on the basis of not only the restoration of articular congruity and physeal anatomy but also the restoration of physeal function, as evidenced by the continuation of normal growth. The mechanism of injury, clinical evaluation, treatment, and outcomes for all epiphyseal injuries about the knee are discussed, as well as differences from adult injuries.