Injuries of the distal femoral growth plate and epiphysis: should open reduction be performed?

A retrospective study for the period 1978-91 revealed 33 patients with fractures involving the distal femoral growth plate and epiphysis. Treatment by closed reduction and casting resulted in a high rate of loss of position. Twenty-three of the patients were followed up for an average of 4.8 years. Salter-Harris type II fractures predominated. An analysis of this group showed that treatment by open reduction and internal fixation gave better results than closed reduction and casting, or percutaneous fixation. The authors advocate treating all displaced Salter-Harris type II, III and IV fractures by open reduction and internal fixation. If closed means are employed, extra care needs to be taken in short- and long-term follow up, and the patient and parents advised of the likelihood of loss of position, deformity and/or growth disturbance.