Abstract
An 18-year-old male suffered a valgus injury to the right knee due to a fall during a bigfoot race he took part in when he was 15 years old. He visited a different hospital at the age of 15. No obvious ligament injury or fracture was noted on MRI and physical examination. However, he gradually became aware of the valgus deformity of the right knee. Finally, he could not take part in a sports activity because of right knee pain. X-ray images at the age of 18 at an initial visit to our department showed severe valgus deformity with mechanical lateral distal femoral angle (mLDFA) of 71 degrees in contrast to left mLDFA which was 87 degrees. We performed a biplane-cut distal femoral varus osteotomy (DFO). Postoperative X-ray images showed an improvement of 86 degrees in mLDFA. Bony fusion was achieved six months after surgery, and he could play several sports activity.
Highlights
Fractures of the distal femoral growth plate are remarkable in that they are the third most common growth plate fracture in children, yet they carry a risk of growth disturbance in up to 90% of cases [1]
We report a case of distal femoral osteotomy for a valgus knee after a distal femoral perichondral ring injury (Rang’s type VI) in a growing male patient
We believe SH (Rang) type VI perichondral ring injury was initially present because the fracture was caused by a valgus injury and hemorrhage around the peripheral structure of the growth plate and no obvious signs of a fracture were noted on MRI
Summary
Fractures of the distal femoral growth plate are remarkable in that they are the third most common growth plate fracture in children (after wrist and ankle), yet they carry a risk of growth disturbance in up to 90% of cases [1]. X-ray images taken at the time of injury (at age 15) showed no obvious fractures or growth plate fractures (Figure 3). Similar to the X-ray images, MRI performed at the age of 17 showed a bony bridge on the lateral side of the growth plate. Based on these findings, the patient was diagnosed with a valgus deformity of the knee due to traumatic premature closure of the femoral growth plate. Valgus deformity has improved in appearance, whereas lower limb length discrepancy (SMD) improved to -0.5 cm in the left lower limb and the range of motion of the right knee improved to 0 (extension) to 150 (flexion) degrees (Figure 8). The KOOS showed that there was a significant improvement in symptoms, pain, sports, and quality of life
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