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Transphyseal Fracture of the Distal Part of the Femur in a NewbornA Case Report
Antonia F. Chen, MD, MBA1; Vincent F.X. Deeney, MD2
1 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 6326 Marchand Street, Pittsburgh, PA 15206
2 Division of Pediatric Orthopaedics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, 4401 Penn Avenue, 4th Floor, Pittsburgh, PA 15224. E-mail address for V.F.X. Deeney: deeneyvf@upmc.edu
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Investigation performed at the Department of Orthopaedic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jan 23;3(1):e8 1-5. doi: 10.2106/JBJS.CC.L.00087
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Extract

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.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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