An Anatomic Reduction Technique for Salter-Harris Type III Medial Femoral Condyle Fractures.

UNLABELLED: Salter-Harris type III (SH-III) distal femur fractures are challenging to manage given their intra-articular nature and physeal involvement. Inadequate reduction of these injuries can potentiate growth disturbances, including premature physeal closure and subsequent deformity. Existing literature lacks a description of a standardized reduction technique for this fracture pattern. In this report, we use a cadaver knee to demonstrate a structured reduction maneuver for the SH-III medial femoral condyle fracture, designed to facilitate anatomic alignment of the epiphyseal fragment via closed or minimally invasive means. The technique involves manipulating the fracture with the knee in a gently flexed position. In this position, the lower leg is externally rotated while a varus force is applied to the knee. This allows the medial meniscus to aid in reducing the medial femoral condyle into its anatomic position. We also present clinical cases demonstrating the in vivo success of the maneuver in achieving reduction of SH-III medial femoral condyle fractures. This technique strategically uses the local anatomy to achieve anatomic reduction without the need for aggressive manipulation.

KEY CONCEPTS: (1)Anatomic reduction of Salter-Harris type III distal femoral fractures is critical to preserving physeal integrity and joint congruity.(2)An external rotation maneuver of the leg, while applying a varus force to the knee, can reproducibly restore alignment in a Salter-Harris type III medial femoral condyle fracture.(3)The technique exploits the juxtaposition of the medial meniscus to aid in condylar reduction.(4)The reduction method may allow percutaneous fixation with minimal intraoperative soft-tissue dissection and may reduce the need for extensive open reduction.