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Abstract: The patient was a 15-year-old student who fell while riding a bicycle and subsequently developed pain and swelling in the knee joint. After physical examination and radiography, a diagnosis of epiphyseal fracture was made. The fracture was fixed with a brace and closed reduction internal fixation was performed. 6 months after surgery, the fracture healed and the patient returned to normal walking.
Basic information】Male, 15 years old
Disease Type】Epiphyseal fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan] Brace fixation + medication (mannitol injection, celecoxib capsule) + fracture closed reduction internal fixation
Treatment Period】10 days in hospital, review after 1 month
Results】The fracture healed and the walking returned to normal
I. Initial consultation
The patient is a student, only 15 years old, but her height is 175cm and her weight is 90kg, which is the same as that of an adult. The patient was brought to the emergency room with knee pain, swelling and inability to walk after a bicycle fall, and was found to have skin abrasions below the patella with significant swelling and localized pressure pain. Although the patient was tall, the film showed that the patient had an epiphyseal fracture and the epiphyseal plate above the tibia had not completely healed, indicating that the bone was still in the growth phase, and the fracture had torn part of the epiphyseal plate, resulting in epiphyseal separation.
II. Treatment history
After admission, the patient was first fixed with a knee brace in the extended position to reduce the pull of the lower leg on the separated epiphysis and to facilitate intraoperative repositioning. Subsequently, CT 3D reconstruction of the knee joint was completed to clarify the type of fracture and the shape of the fracture mass. The patient was given elevation of the affected limb, ice packs, intravenous mannitol injection to reduce swelling, and oral celecoxib capsules to relieve pain. Routine preoperative tests such as routine blood, liver and kidney functions, and coagulation were completed. On the third day after admission, the patient was treated with closed reduction internal fixation of the fracture, using intraoperative fluoroscopy to reposition and fix the fracture while trying to avoid causing secondary medically induced injury to the epiphyseal plate. The incision was changed every other day after surgery and discharged after 10 days of treatment. The patient was instructed to review after 1 month.
III. Treatment results
The patient’s pain in the fracture area was relieved on the 2nd day after surgery, the surgical incision was mildly painful, and there was no significant swelling in the affected limb. On the 3rd day after surgery, the knee joint could be moved passively and the knee could be flexed up to 30°. On the 10th day of hospitalization, the knee joint could be passively flexed up to 90° and the skin of the lower limb felt normal without obvious swelling. There was no necrosis or infection in the incision after surgery, and the stitches were removed 2 weeks after surgery. Six weeks after surgery, the flexion and extension activities of the affected limb returned to normal, and 6 months after surgery, the fracture healed and walking returned to normal.
IV. Notes
We are glad that the patient returned to normal walking after treatment. Since fractures heal much faster in adolescents than in adults, timely review is needed to observe the fracture healing. For this patient, x-rays need to be taken every 3 months after surgery. Active muscle contraction exercises should be performed while bedridden to avoid joint stiffness and muscle atrophy. The patient will be able to get out of bed gradually 6 weeks after surgery. Due to the patient’s heavy weight, he should be on crutches or with the help of two people in the early stages of getting out of bed. During the fracture healing period, attention should be paid to calcium intake and a balanced diet, and the internal fixation should be removed after the fracture heals.
V. Personal insight
Adolescent fracture is different from adult fracture, which can be completely recovered by proper treatment after adult fracture, but the epiphysis and epiphyseal plate still exist at both ends of adolescent bones, and once the fracture affects this structure, it is likely to affect bone growth. Although this patient is about the same size as an adult, the epiphyseal plates are still visible at both ends of the skeleton, indicating that his cartilage proliferation and osteogenesis are not yet complete and he will grow taller. From the imaging, the patient’s fracture has damaged the epiphyseal plate, so even if surgery is performed to avoid epiphyseal plate damage, the patient may still have skeletal growth disorders in the future, so adolescents should protect themselves from fractures during sports or activities.