Transphyseal Fracture of the Distal Part of the Femur in a Newborn: A Case Report.

Abstract

Transphyseal separations of the distal part of the femur are infrequently seen in newborns. These fractures are often caused by birth injuries (e.g., during breech deliveries)1,2. There is swelling in the affected extremity and pain with palpation, and the transphyseal separation can be confused with a septic joint. Patients must be imaged appropriately with use of radiographs and magnetic resonance imaging (MRI) to detect more subtle fractures2. When the diagnosis of distal femoral physeal separation has been made, treatment choices include closed reduction only, closed reduction and percutaneous pinning, or open reduction and percutaneous pinning. Previous case reports have described percutaneous pinning as the preferred method of treatment in neonates3,4. However, this case report describes a transphyseal fracture of the distal part of the femur diagnosed at seven days of age in a neonate; the fracture was repositioned at the bedside without administering general anesthesia, and it was adequately treated in a long leg splint. The two-year follow-up demonstrated complete remodeling and no clinical sequelae from the injury. The patient's parents were informed that data concerning the case would be submitted for publication, and they provided consent. A 1.53-kg twin infant was born at thirty-four weeks to a forty-two-year-old G1 P1 woman. The infant was spontaneously vaginally delivered and was born in a footling breech position. While the infant was in the neonatal intensive care unit (NICU) for seven days receiving a gastrointestinal workup for abdominal distention and bilious aspiration, it was noted that there was swelling superior to the left knee and that he would cry when the knee was palpated. These finding were concerning for a septic joint, and an orthopaedic consultation was obtained. The patient had no noteworthy medical history, but the mother had a history of …