(ii) Paediatric epiphyseal fractures around the knee

SummaryPhyseal fractures around the knee are most common in children aged 9–14. The majority of these fractures will have a good outcome if they are adequately treated initially. There is a fairly clear consensus on how these fractures should be managed. Undisplaced fractures are treated with cast immobilisation and almost universally have a good outcome. Displaced Salter Harris I and II fractures of the proximal tibia and distal femur can usually be treated with closed reduction and fixation. Intraarticular fractures often require open reduction prior to internal fixation. Displaced fractures of the tibial spine, tibial tuberosity and patella are more difficult to reduce closed and an open reduction is frequently required. Most osteochondral fractures are simply excised arthroscopically. There are well recognised complications associated with paediatric knee fractures. Early complications include popliteal artery damage, ligament damage and compartment syndrome. Late complications are usually related to damage to the physis with leg length discrepancies and angular deformity.