Diagnosing, Treating, Preventing Knee Fractures in Children Require a Different Approach

The knee is a common site of injury in children and teenagers, especially those involved in competitive sports. Because children's knees are changing and growing, it is important that physicians treating children be familiar with the types of injuries and complications as well as the diagnostic and treatment procedures unique to this age group, according to a study published in the September/October 2002 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), Vol. 10, No. 5.

Lewis E. Zionts, MD, Professor, Department of Orthopaedics and Pediatrics, Keck School of Medicine, University of Southern California, and Director of Pediatric Orthopaedics, Women's and Children's Hospital, University of Southern California, studied fractures of the immature knee, including those involving the knee's growth plate within the joint, thighbone (femur), shinbone (tibia), kneecap (patella), and cartilage, to determine the most accurate diagnostic methods and to predict the long-term outcome of injuries and their treatment.

The results of this study are detailed diagnostic and treatment recommendations for diagnosing, classifying, treating, and following up the most common types of knee fractures in children.

The knee joint in children is different from that in adults. Cartilage, the elastic, connective tissue that acts as a cushion between bones in a joint, makes up more of the skeleton in a child than does bone in order that the child may grow. As a child grows, skeletal cartilage slowly converts to bone. During childhood, however, the rich supply of cartilage in a growing child's knee may make a diagnosis more difficult because a standard X-ray may fail to detect a fracture in cartilage or surrounding structures. A physician treating a child may need to use computed tomography (CAT) scanning or magnetic resonance imaging (MRI) to help establish a diagnosis.

The study also found that because of other features characteristic of children's anatomy, knee fractures in youngsters may also be susceptible to complications such as nerve and circulatory impairment at the fracture site, poor union of fragments in fractures, or damage to the growth plates. Therefore, a physician treating a child must be alert to these types of potential problems.

Zionts concludes that the physician's awareness of the unique kinds of fractures occurring around the knee of a growing child cannot be overemphasized. Diagnosis and management of each case involve more than just achieving recovery. Because of their special anatomical structures and physiological processes, children's knees are vulnerable to complications not encountered in adult knee fractures.

The child's future growth is also a primary consideration. Physicians, accordingly, need to identify accurate diagnostic techniques, apply appropriate treatment, and anticipate potential complications.

In addition, physicians must encourage an ongoing discussion with both the patient and the parents about symptoms, treatment, care, and the need for follow-up to detect and manage any complications. Eager young athletes and their parents need to understand the necessity of following treatment programs and maintaining follow-up plans to ensure trouble-free recovery and prevent future problems

An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, muscles, and nerves.The Journal of the American Academy of Orthopaedic Surgeons is an official review publication of the 26,047-member Academy, a not-for-profit organization which provides educational programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy supports the United Nations-declared Bone and Joint Decade, 2000-2010. The peer-reviewed JAAOS is published bimonthly. Abstracts are available online at http//www.jaaos.org.