Approach to the Physeal Bar after Distal Femur Fracture
The distal femoral physis is vulnerable to growth arrest after Salter I and II injuries because of the high energy and undulating morphology of the plate – the injury may go through the resting and proliferating zone of cartilage cells
Treatment depends on age and degree of growth disturbance
Be aware that 40% of the limb growth is at the distal femoral physis; it typically contributes 7-10 mm of longitudinal growth per year!
Therefore – if 5 years of growth remaining and the whole physis has shut down – anticipate 5 cm leg length discrepany at least.
Consider: shoe lift, contralateral epiphyseodesis of femur and tibia
Resect physeal bar if less than 50% – map with MRI; approach from the metaphyseal side, resect until you see normal physeal cartilage, then fill with fat or cement. Leave metal markers in place to tell you how things are growing later.
If varus or valgus of more than 10 degrees exists at the time of resection – correct that too with a distal femoral osteotomy.