[Deformities around the knee after growth plate injuries: Analysis and correction]

Growth plate injuries of the distal femur and the proximal tibia are rare, but may induce deformities around the knee. The type of primary injury and the patient's age at the time of injury influence the extent and complexity of the deformity.

Twelve patients (median age = 12 years; range = 7-16 years) experienced growth plate injuries of the knee, followed by post-traumatic deformities. In fully developed growth plates, the deformities were subjected to a comprehensive and standardized analysis. Eleven patients had deviations in the frontal plane and 9 patients in the sagittal plane. Ten patients had relevant length differences and 7 patients had torsional deviations. One of the deformities was unidimensional, one was two-dimensional, six were three-dimensional, and four were four-dimensional. Ten corrective osteotomies were performed in the femoral aspect and 5 in the tibial aspect. Three patients needed bifocal osteotomies. Eight osteotomies were performed with an oscillating saw and 7 osteotomies with a drill hole and chisel. Acute correction could be achieved in 4 cases and continuous correction by means of callus distraction in 5 cases, whereas 3 patients needed combined procedures.

One arterial injury had to be treated immediately by performing acute vascular surgery. A pin tract infection healed after early removal of the external fixator for distraction. Delayed bone healing necessitated a local revision with cancellous bone grafting. The goals of correction and acceptable knee function were achieved in all patients.

Growth plate injuries frequently cause very complex deformities. A comprehensive and structured analysis of the deformity and customized acute/continued corrective procedures are essential for a satisfactory anatomic and functional outcome.