An Unusual Case of a Distal Femur Salter-Harris Type IV Displaced Fracture Managed Conservatively

Abstract

Introduction: Distal femoral epiphyseal fractures are rare, accounting for 1–6% of all physeal injuries. Salter-Harris type IV fractures in particular carry a high risk of long-term sequelae, most of which relate to growth disturbance. Prompt diagnosis and appropriate management are therefore essential. Presentation of Case: A 13-year-old boy sustained a displaced intra-articular Salter-Harris type IV fracture of the right distal femur during a football game. The injury was confirmed on radiographs and computed tomography (CT). The fracture was reduced under sedation; because post-reduction imaging demonstrated a stable, minimally displaced configuration, it was managed conservatively in an above-knee plaster splint, with non-weight-bearing immobilisation for four weeks followed by graduated physiotherapy. At six months, he had regained full, pain-free knee function with no complications. Discussion: Salter-Harris type IV fractures of the distal femur are rare and carry a high risk of growth disturbance. Plain radiographs may underestimate physeal displacement, so cross-sectional imaging assists with accurate classification and planning. Although operative fixation is frequently required, a stable and well-reduced fracture may be managed conservatively with close radiographic monitoring. Conclusion: Accurate classification depends on appropriate imaging. In carefully selected fractures that are stable and adequately reduced, conservative management combined with close radiographic monitoring can achieve an excellent outcome. Patient and family education is central to reducing the risk of complications.