The guarded prognosis of physeal injury in paraplegic children.

Unrecognized injury of the physis in neurologically impaired children, followed by repetitive trauma due to lack of sensation, results in a bizarre roentgenographic appearance which may resemble that of osteomyelitis or a malignant tumor (sarcoma or leukemia). The prolonged process of injury and repair in the injured physis and adjacent metaphysis is similar to that seen in Charcot neuroarthropathy. Lack of awareness of these roentgenographic features resulted in unnecessary diagnostic biopsy in two of the nine patients with such fractures reported in this study. Delayed healing is characteristic of this lesion and is a result of inadequate immobilization and failure to restrict weight-bearing. Premature closure of the physis occurred in five of nine patients. Early recognition and adequate immobilization allow more normal healing of this unusual injury.