Fig. 82.—Radiogram of Separation of Lower Epiphysis of Femur, with backward displacement of the diaphysis; pressure on popliteal vessels caused sloughing of calf.
Fig. 83.—Separation of Lower Epiphysis of Femur, with fracture of lower end of diaphysis.
The treatment is the same as for supra-condylar fracture, but, owing to the serious disability that follows on incomplete reduction, it may be necessary to have recourse to operation. After an epiphysial separation, the growth of the limb is sometimes, although not always, interfered with.
Either condyle may be broken off without the continuity of the shaft being interrupted, by a direct blow or fall on the knee, or by violent twisting of the leg. The separated condyle may not be displaced, or it may be pushed upwards or rotated on its transverse axis.
There is broadening of the knee but no shortening of the thigh, and the ecchymosis, crepitus, and pain are localised to the affected side of the joint; the knee can usually be moved towards the injured side in a way that is characteristic. If allowed to unite with the condyle displaced, the articular surface is oblique and bow- or knock-knee results.
If there is difficulty in replacing the broken condyle and maintaining it in position, it may be fixed by means of a steel nail inserted through the skin.
