PMC9622785_01
3D CT reconstruction of physis injuries of the left knee in anterior view (A), in posterior view (B), inlet view (C), and 2D CT coronal view (D).
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F1
She had a fracture of the right ischiopubic branch, a lesion of the distal femoral and proximal tibia physis of the left knee, both type IV according to the Salter-Harris classification; a bifocal fracture of the left fibula; and diffuse torn wounds (Figure 1).
Postoperative x-ray control after reduction and synthesis of left knee growth plate fractures.
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F2
Once stabilized, she was transferred to the Traumatology Department and underwent closed reduction surgery and internal fixation with cannulated screws for femoral and tibial fractures of the growth plate (Figure 2).
Four months postoperative x-ray showing a valgus (20 ) of the left lower limb and the absence of dysmetria (A). CT scans confirm the presence of femoral bone bridge in three different projections (B-D). (B) shows that the bony bar is 30% of the entire area of the growth plate.
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F3
For this reason and with the diagnostic suspicion of femoral bony bar formation or growth arrest, the patient underwent a CT scan that confirmed the presence of femoral bone bridge (Figure 3).
X-ray (A,B) and MRI (C-E) highlighted the results of the recent de-epiphysiodesis operation with placement of bone wax and minimal residual bone bridge.
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F4
About a month after the second surgery, the patient underwent an MRI scan that highlighted the results of the recent de-epiphysiodesis operation with placement of bone wax and minimal residual bone bridge of limited entity (2 mm x 4 mm) compared to the previous CT control (Figure 4).
Bone scintigraphy highlighted an hypercaptation of the lateral portion of the left femoral physis.
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F5
The patient underwent further II level investigation 18 months after trauma such as a bone scintigraphy that noticed an area of growth plate hypercaptation around the surgically performed bone hole sign of metabolic overactivity of the growth cartilage around the bone wax area (Figure 5).
Twenty-month post-trauma follow-up showing 20  valgus deviation of the left knee with respect to the contralateral side. (A) showing clinical results, (B) showing radiological results.
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F6
At 20-month post-trauma follow-up, the left knee was valgus about 20  relative to the other side with an acquired length discrepancy of 14 mm and compensatory pelvic obliquity (Figure 6).
Ten-year post-trauma follow-up showing complete clinical (A) and radiological (B) recovery.
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F7
Clinical and radiographic control 10 years after the trauma showed a complete recovery of the axis of the lower limbs associated with the absence of limitations on the left knee; in addition, the x-rays confirmed the known lowering of the left hemipelvis of about 20 mm and the known morpho-structural alteration localized at the level of the distal third shaft of the left femur as a result of the bone wax placement surgery (Figure 7).