Neglected pediatric distal femoral physeal fracture with growth arrest and progressive genu valgum: a case report
Ali Faraj, Hamza Khaiata, Mohammad Kokash, Linda Alkhouri, Mohamed Issa, Hamza WardaIntroduction and importance:
Neglected epiphyseal fracture-separations of the distal femur occur when management is delayed, potentially causing partial physeal arrest and progressive angular deformity. Given the substantial contribution of the distal femoral physis to lower-limb development, timely intervention is important to restore alignment.
Case presentation:
A 3.5-year-old female sustained a Salter–Harris type III right distal femoral fracture, initially managed conservatively with a hip spica cast. Three months post-injury, she presented with limping, discomfort, and a progressive valgus deformity. Radiographs demonstrated asymmetric physeal closure and localized growth arrest. Surgical correction was performed using a dome-shaped corrective osteotomy combined with Kirschner-wire fixation. The spica cast was removed at 6 weeks, and the wires were extracted at 3 months. Clinical and radiographic evaluation at an extended, 18-month follow-up demonstrated pain-free ambulation, excellent functional recovery on the Pediatric Quality of Life Inventory (PedsQL parent-proxy score of 94/100), and stable maintenance of anatomical limb alignment symmetrical with the contralateral side.
Clinical discussion:
The combination of a dome osteotomy and K-wire fixation offered a technically feasible, minimally invasive alternative for acute anatomical alignment and structural stabilization. However, because the patient is highly skeletally immature, vigilant long-term surveillance until skeletal maturity remains essential to identify and manage potential growth-related deformity recurrence.
Conclusion:
Acute surgical realignment via a dome osteotomy and K-wire fixation provides a satisfactory short- to mid-term option for restoring anatomical alignment and clinical function, although diligent long-term monitoring until skeletal maturity is required.