This type of fracture can occur when the knee is struck head-on, as when a child runs into something knee first. The patient typically complains of pain. I look for point tenderness at the physis and joint line. I also assess knee stability, as well as motor, circulatory, and sensory function distal to the injury. Comparison radiographic views of the uninjured knee often resolve doubts in cases of an undisplaced fracture.
Treatment depends on the fracture pattern and amount of displacement.
These fractures, if unstable, can usually be reduced by manipulation and internally fixed percutaneously. With a type III or type IV fracture, arthroscopic assessment is helpful to document anatomic articular reduction and to detect other intraarticular injuries such as meniscal tears. These patients do well overall. There seems to be less potential for growth arrest and subsequent deformity than with fractures of the distal femoral epiphysis. This injury is usually due to anterior-posterior forces, so there is a heightened risk of neurologic or vascular compromise, with the potential for the development of a compartment syndrome as well.