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Matías Sepúlveda Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile
AO Foundation, PAEG Expert Group, Davos, Switzerland

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Cecilia Téllez Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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Víctor Villablanca Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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Estefanía Birrer Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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  • The physis of the distal femur contributes to 70% of femoral growth and 37% of the total limb growth; therefore, physeal injury can lead to important alterations of axes and length.

  • Distal metaphyseal corner-type fracture prior to walking is classically associated with child abuse. In children aged >10 years, sports-related fractures and car accidents are significant contributors.

  • Imaging includes a two-plane radiographic study of the knee. It is recommended to obtain radiographs that include the entire femur to rule out concomitant injuries. In cases of high suspicion of distal metaphyseal fractures and no radiographic evidence, CT or MRI can show the existence of hidden fractures.

  • Fractures with physeal involvement are conventionally classified according to the Salter–Harris classification, but the Peterson classification is also recommended as it includes special subgroups.

  • Conservative and surgical management are valid alternatives for the treatment of these fractures. Choosing between both alternatives depends on factors related to the fracture type.

  • As there is a high risk of permanent physeal damage, long-term follow-up is essential until skeletal maturity is complete.

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Ignacio Rodriguez Universidad Austral de Chile, Valdivia, Chile

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Matías Sepúlveda Universidad Austral de Chile, Valdivia, Chile
AO Foundation, PAEG Expert Group, Davos, Switzerland
Hospital Base de Valdivia, Valdivia, Chile

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Estefanía Birrer Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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María Jesús Tuca Clinica Alemana, Santiago, Chile
Universidad del Desarrollo, Santiago, Chile
Hospital Clínico Mutual de Seguridad, Santiago, Chile

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  • Fractures of the anterior tibial tuberosity during childhood are an infrequent pathology (around 3% of all proximal tibial fractures), but the incidence of this injury has risen over recent years, likely due to the increased involvement of this age group in sports activities.

  • This fracture is more commonly seen in children 12–14 years old.

  • It is vital to identify the anatomical structures associated with this type of fracture, along with the pathophysiological mechanisms involved.

  • Treatment includes non-operative and operative options, with the goal of achieving articular congruency, restoring the extensor mechanism function, and avoiding damage to the proximal tibial physis.

  • Understanding the management of this fracture, and the complications that might arise, is critical. The provision of an appropriate clinical management plan and the avoidance of complications are vital in the prevention of disability.

Cite this article: EFORT Open Rev 2020;5:260-267. DOI: 10.1302/2058-5241.5.190026

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Marco Gupton MountainView Regional Medical Center, Orthopaedic Surgery Residency, Las Cruces, New Mexico, USA

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Jessica Burns Department of Orthopaedic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA

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kingae in children with culture-negative septic arthritis in eastern Ontario . Paediatrics and Child Health 2016 21 79– 82 . ( https://doi.org/10.1093/PCH/21.2.79 ) 27095882 101. Hernández-Rupérez MB Suárez-Arrabal MDC Villa-García Á Zarzoso

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