Unusual physeal lesions of the lower limb. A report of 16 cases with very long-term follow-up observation

Sixteen cases of physeal injury of the hip or the knee were reviewed, with an average follow-up observation of 23 years and 8 months. Obstetric lesions were present in four cases. The average patient's age at injury was 8 years and 6 months, whereas it was 32 years and 3 months at follow-up observation. All our cases but three were treated nonoperatively. According to our evaluation criteria, eight patients had a good result, three fair, and five poor. A lower limb discrepancy ranging from 1.5 to 6 cm was present in seven patients. Either varus or valgus angulation of the knee was observed in three patients, but was marked in only one. Four patients had radiographic signs of osteoarthritis and all but one, had had a type III or IV injury. The highest number of good results was observed in proximal femur injuries, whereas the highest number of poor results was found in those of the distal femur. The final result seems to be closely related, in distal femoral lesions, to the type of physeal injury according to Salter and Harris and, in proximal tibial lesions, to the quality of reduction. In obstetric lesions, the results are unpredictable because even good short-term results may deteriorate during skeletal growth.