Circular External Fixation for Distal Femoral Physeal Injury: A Case Report

Takahiro Sato1, *, Shuichi Chida2, Koji Nozaka1, Moto Kobayashi2, Tsutomu Sakuraba2, Ken Sasaki2, Naohisa Miyakoshi1
1 Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
2 Department of Orthopedic Surgery, Hiraka General Hospital, 3-1 Maego aza Yatsuguchi, Yokote, Akita 013-8610, Japan

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© 2022 Sato et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan; Tel: +81-18-884-6148; Fex: +81-18-836-2617; E-mail:



Distal femoral physeal injuries are a challenging clinical scenario because the injuries have a high risk of growth disturbance. The selected treatments include closed reduction and cast immobilization, percutaneous pin fixation, and cannulated screws or internal fixation, but these treatments have some complications. Circular external fixation enables rigid immobilization and walking with full weight bearing. To the best of our knowledge, there is no article on the results of using circular external fixation for distal femoral physeal injury. This case is the first in which circular external fixation for distal femoral physeal injury is used.

Case Presentation:

A 9-year-old boy was injured in a skiing accident, and his injury was a Salter-Harris type II fracture of the distal femoral epiphysis. We immediately performed percutaneous pin fixation with circular external fixation under general anesthesia. After surgery, he was allowed to walk with full weight bearing. One year after surgery, he had no pain, and his knee regained full extension and 140°flexion.


We consider circular external fixation to be an effective treatment option because of its rigid immobilization without injury to the plate. However, we and patients must fully acknowledge its difficulties (i.e., pin-site problems, neurologic injury, vascular injury, joint stiffness, and pain, and difficulty sleeping).

Keywords: Distal femoral physeal injury, Circular external fixation, Growth arrest, Injury, Patients, Immobilization.