{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:04:10Z","timestamp":1779681850721,"version":"3.53.1"},"reference-count":16,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Distal femoral physeal fractures are rare and particularly uncommon in very young patients, as they typically require a significant amount of kinetic energy. They carry a high risk of premature physeal closure and later growth disturbance. We aimed to describe the management and long-term outcome of an open distal femoral physeal fracture in a 6-year-old child. Methods: We report a previously healthy 6-year-old child sustained an open distal femoral physeal fracture in an electric scooter\u2013motor vehicle collision. Emergency treatment included trauma assessment, resuscitation, intravenous cefazolin, urgent irrigation and debridement, open reduction, crossed smooth Kirschner-wire fixation, and immobilization. Long-term follow-up included growth prediction using the multiplier method. Results: The injury was classified intraoperatively as a Salter\u2013Harris type I distal femoral physeal fracture. Despite timely surgical treatment, progressive limb-length discrepancy developed, increasing from 1.3 cm at 10 months to 6.5 cm over 5 years. Growth prediction estimated a final discrepancy of 7.32 cm at skeletal maturity, and contralateral distal femoral epiphysiodesis was performed. The literature confirms that displaced high-energy distal femoral physeal injuries in younger children carry a substantial risk of premature physeal closure and later corrective surgery. Conclusions: Open high-energy distal femoral physeal fractures in young children are limb-growth-threatening injuries. This case demonstrates that satisfactory initial fracture management does not eliminate the risk of later premature physeal closure, and that clinically important discrepancy evolves gradually over several years. Long-term follow-up and growth prediction are essential to guide timely corrective treatment to minimize the leg-length discrepancy in bone maturity.<\/jats:p>","DOI":"10.3390\/children13060726","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T02:32:28Z","timestamp":1779676348000},"page":"726","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Open Distal Femoral Physeal Fracture in a 6-Year-Old Child Complicated by Growth Arrest and Limb-Length Discrepancy: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8183-2918","authenticated-orcid":false,"given":"Egl\u0117","family":"Jauni\u0161kyt\u0117","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6268-0326","authenticated-orcid":false,"given":"Giedr\u0117","family":"\u017dulpait\u0117","sequence":"additional","affiliation":[{"name":"Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Labanauskien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Children\u2019s Diseases, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"348","DOI":"10.2340\/17453674.2023.13654","article-title":"Epidemiology and risk factors for premature physeal closure in distal femur fractures","volume":"94","author":"Koivisto","year":"2023","journal-title":"Acta Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/BPB.0000000000000664","article-title":"Physeal fractures of the distal femur: Does a lower threshold for surgery lead to better outcomes?","volume":"29","author":"Adams","year":"2020","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1530\/EOR-21-0110","article-title":"Distal femoral fractures in children","volume":"7","author":"Villablanca","year":"2022","journal-title":"EFORT Open Rev."},{"key":"ref_4","first-page":"e38679","article-title":"A distal femoral Salter\u2013Harris IV fracture secondary to a motocross accident: A case report","volume":"15","author":"Bridwell","year":"2023","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/BPB.0000000000000733","article-title":"Evaluation of pediatric distal femoral physeal fractures and factors impacting poor outcome requiring further corrective surgery","volume":"30","author":"Bellamy","year":"2021","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hedequist, D.J., and Heyworth, B.E. (2016). Physeal, epiphyseal, and intra-articular fractures of the distal femur. Pediatric Femur Fractures, Springer.","DOI":"10.1007\/978-1-4899-7986-5"},{"key":"ref_7","first-page":"e57937","article-title":"Comprehensive review on distal femur fractures: From epidemiology to treatment strategies","volume":"16","author":"Singh","year":"2024","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"222","DOI":"10.4103\/JETS.JETS_40_21","article-title":"Approach to suspected physeal fractures in the emergency department","volume":"14","author":"Singh","year":"2021","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s43465-020-00338-6","article-title":"Management of physeal fractures: A review article","volume":"55","author":"Singh","year":"2021","journal-title":"Indian J. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s12178-016-9370-7","article-title":"Physeal fractures about the knee","volume":"9","author":"Little","year":"2016","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.17816\/PTORS7379-84","article-title":"Open traumatic distal femoral physeal fracture in a pediatric patient with tetrasomy 18p syndrome","volume":"7","author":"Arain","year":"2019","journal-title":"Pediatr. Traumatol. Orthop. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e413","DOI":"10.1097\/BPO.0000000000002911","article-title":"Factors associated with premature physeal closure after distal femur physeal fracture","volume":"45","author":"Hulbert","year":"2025","journal-title":"J. Pediatr. 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Orthop."},{"key":"ref_16","first-page":"405","article-title":"Leg Length Discrepancy\u2014Treatment Indications and Strategies","volume":"117","author":"Vogt","year":"2020","journal-title":"Dtsch. \u00c4rztebl. Int."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/726\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T03:25:35Z","timestamp":1779679535000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/726"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,23]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["children13060726"],"URL":"https:\/\/doi.org\/10.3390\/children13060726","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,23]]}}}