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Fractures Around the Knee in Children

Dr. Zionts is Professor, Department of Orthopaedics and Pediatrics, Keck School of Medicine, University of Southern California, and Director, Pediatric Orthopaedics, Women’s and Children’s Hospital, University of Southern California Medical Center, Los Angeles, CA.

Reprint requests: Dr. Zionts, Room 3L-31, 1240 North Mission Road, Los Angeles, CA 90033.

Traumatic forces applied to the immature knee result in fracture patterns different from those in adults. The relative abundance of cartilage in the knee of the growing child may make the diagnosis of certain injuries more challenging. If plain radiographs fail to reveal a fracture, a stress radiograph, computed tomography scan, or magnetic resonance imaging study may help to establish the diagnosis. Certain fractures, such as hyperextension injuries to the distal femoral or proximal tibial epiphysis, or displaced tibial tuberosity fractures, may be especially susceptible to neurovascular problems. Although the use of appropriate treatment techniques may minimize the occurrence of late complications such as malunion and physeal bridging, not all problems are preventable. A careful discussion of the injury with both patient and parents should stress the importance of follow-up so that any problems that do occur can be promptly addressed.