Salter-Harris type-III fracture of the medial femoral condyle occurring in the adolescent athlete

Abstract

This report adds six Salter-Harris type-III fractures of the medial femoral condyle to the fourteen such fractures that have been previously reported in the English literature. The injury results from a valgus force applied to the knee. As the fracture may reduce spontaneously, radiographs may not be diagnostic and the fracture may be unrecognized or be mistaken for disruption of the medial collateral ligament. If a fracture is suspected, a cross-table lateral radiograph should be made in an attempt to detect fat within the joint fluid and confirm the existence of an intra-articular fracture. An oblique, tunnel (notch), or over-penetrated radiograph may demonstrate the fracture. However, if it fails to do so, radiographs made with valgus stress applied to the knee while the patient is under general anesthesia may be necessary. In our six patients, satisfactory healing of the fracture occurred after either spontaneous or manipulative reduction and subsequent non-weight-bearing immobilization in cylinder cast. Minimum femoral shortening developed in two patients, late anterior cruciate laxity was demonstrable in two patients, and one patient required arthrotomy for removal of an osteochondral fracture fragment.