Narrative review of fracture patterns unique to the immature knee — covering distal femoral and proximal tibial epiphyses, tibial tubercle, tibial spine, patella, osteochondral surfaces, and proximal tibial metaphysis — addressing classification, imaging diagnosis, treatment principles, and anticipated complications in the pediatric population.
When evaluating a child with knee trauma and normal plain radiographs but effusion, swelling, or refusal to bear weight, advance to stress films or MRI — especially for physeal injuries and tibial spine fractures where cartilage makes radiographs unreliable.
For any proximal tibial epiphyseal injury, perform a full vascular exam and maintain a low threshold for arteriography, because the fracture may have partially reduced before arrival and popliteal artery injury can be occult.
Narrative review of fracture patterns unique to the immature knee — covering distal femoral and proximal tibial epiphyses, tibial tubercle, tibial spine, patella, osteochondral surfaces, and proximal tibial metaphysis — addressing classification, imaging diagnosis, treatment principles, and anticipated complications in the pediatric population.
When evaluating a child with knee trauma and normal plain radiographs but effusion, swelling, or refusal to bear weight, advance to stress films or MRI — especially for physeal injuries and tibial spine fractures where cartilage makes radiographs unreliable.
For any proximal tibial epiphyseal injury, perform a full vascular exam and maintain a low threshold for arteriography, because the fracture may have partially reduced before arrival and popliteal artery injury can be occult.