Distal femoral physeal fractures after neonatal osteomyelitis A case report

Rationale: The physeal separations and septic osteomyelitis in newborns are unusual, which represents a challenging problem in diagnosis and treatment. Patient concerns: A 2-day-old mature male suddenly complained by parents about minimal swelling around the left knee, decreased left extremity motion and no fever. Diagnosis: Preliminary x-rays of the lower extremities demonstrated a displaced distal femoral physeal, Laboratory investigation indicated infection. Magnetic resonance imaging and ultrasound showed displaced distal femoral physeal. A needle aspiration confirmed the diagnosis. Intervention: Debridement and ultrasound guide reduction with pinning of physeal separations was performed. Outcome: At 5 years later, his last follow-up showed that there was only 1.6cm limb-length discrepancy without angular deformity, the child did not report any pain and was perfectly able to perform his daily activities. Lessons: Distal femoral physeal fractures after neonatal osteomyelitis requires immediate and reliable decision for management. We point out the important role of the application of sonography, which is helpful to make an early diagnosis and guide reduction and percutaneous pinning of distal femoral physeal fractures.