Epiphyseometaphyseal cupping of the distal femur with knee-flexion contracture.

An 11-year-old child with a history of receiving megadoses of vitamin A as an infant, and a 4-year-old child with a history of fulminant staphylococcal septicemia with multiple joint involvement presented with recalcitrant knee-flexion contractures. Roentgenography revealed epiphyseometaphyseal cupping (ie, epiphyseal invagination) of the distal femur. Osteotomy resulted in only temporary correction. Our experience suggests that in the skeletally immature child, skin traction, physical therapy, splinting, and, in some instances, two-pin tibial traction should be the treatments of choice.