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Closed fracture of femur, lower epiphysis

Last edited: 4/15/2026

Overview

Closed fracture of the femur, specifically involving the lower epiphysis, typically affects adolescents and young adults, often due to high-energy trauma. These fractures can lead to significant functional impairment if not properly managed, emphasizing the need for precise alignment and preservation of growth potential in pediatric cases 1.

Diagnosis

  • Clinical Presentation: Pain, swelling, deformity, and inability to bear weight 1.
  • Imaging: X-rays are essential for initial diagnosis, with CT or MRI recommended for complex or intra-articular fractures to assess displacement and physeal involvement 1.
  • Grading: Utilize the Salter-Harris classification for epiphyseal injuries, though specific grading for the distal femur may vary; alignment and displacement are critical factors 1.

    • Management

  • First-Line Treatment: Non-operative management with skeletal traction or long-leg casting for stable, non-displaced fractures 1.
  • Adjunctive Treatments: Surgical intervention (open reduction and internal fixation) for displaced fractures to ensure anatomical reduction and prevent growth disturbances 1.
  • Monitoring: Regular follow-up imaging to assess alignment and physeal status, particularly in pediatric patients 1.

    • Special Populations

  • Pediatrics: Focus on preserving growth potential; surgical intervention may be preferred for displaced fractures to avoid angular deformity and limb length discrepancies 1.
  • Elderly: Consider osteoporosis and comorbidities; management may involve surgical stabilization to ensure stability and functional recovery 1.

    • Key Recommendations

  • For displaced distal femoral epiphysis fractures in pediatric patients, surgical intervention aiming for anatomical reduction is recommended to prevent growth disturbances and deformity (Evidence: Moderate 1).
  • Stable, non-displaced fractures can be managed non-operatively with skeletal traction or casting, but close monitoring is essential (Evidence: Moderate 1).
  • High-quality prospective multicenter research is needed to definitively establish the superiority of surgical versus conservative management in displaced distal femoral epiphysis fractures (Evidence: Expert opinion 1).

    • References

    1 Peterson N, Perry DC. Displaced distal tibial Salter-Harris II fractures. The bone & joint journal 2023. link

    Original source

    1. [1]
      Displaced distal tibial Salter-Harris II fractures. — Peterson N, Perry DC The bone & joint journal (2023)
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