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The physis of the distal femur contributes to 70% of femoral growth and 37% of the total limb growth; therefore, physeal injury can lead to important alterations of axes and length. Distal metaphyseal corner-type fracture prior to walking is classically associated with child abuse. In children aged >10 years, sports-related fractures and car accidents are significant contributors. Imaging includes a two-plane radiographic study of the knee. It is recommended to obtain radiographs that include the entire femur to rule out concomitant injuries. In cases of high suspicion of distal metaphyseal fractures and no radiographic evidence, CT or MRI can show the existence of hidden fractures. Fractures with physeal involvement are conventionally classified according to the Salter–Harris classification, but the Peterson classification is also recommended as it includes special subgroups. Conservative and surgical management are valid alternatives for the treatment of these fractures. Choosing between both alternatives depends on factors related to the fracture type. As there is a high risk of permanent physeal damage, long-term follow-up is essential until skeletal maturity is complete.

Lower extremities axis alterations are a frequent cause for consultation in the medical practice of the care of paediatric patients. When it corresponds to pathological situations, guided growth surgery has been positioned as a possibility of well tolerated, reproducible and predictable resolution. For this reason, its use has increased significantly in recent years. In this review, its current indications, preoperative study, results and complications described in the updated literature will be discussed.The success of the technique remains high in the current literature, expanding the technique to other segments and disorders, and describing new ways of performing tension band with sutures. In addition, there is an increase in its incidence and a decrease in the associated hospitalized days, which can associate with techniques of lower morbidity.As guided growth surgery allows for successful correction of axis alterations, to achieve this, it is important to know the main indications, preoperative analysis and theoretical bases on which this technique is based, to carry it out in an adequate and timely manner, seeking an adequate resolution of the child's problem.

Fractures of the anterior tibial tuberosity during childhood are an infrequent pathology (around 3% of all proximal tibial fractures), but the incidence of this injury has risen over recent years, likely due to the increased involvement of this age group in sports activities. This fracture is more commonly seen in children 12–14 years old. It is vital to identify the anatomical structures associated with this type of fracture, along with the pathophysiological mechanisms involved. Treatment includes non-operative and operative options, with the goal of achieving articular congruency, restoring the extensor mechanism function, and avoiding damage to the proximal tibial physis. Understanding the management of this fracture, and the complications that might arise, is critical. The provision of an appropriate clinical management plan and the avoidance of complications are vital in the prevention of disability.Cite this article: EFORT Open Rev 2020;5:260-267. DOI: 10.1302/2058-5241.5.190026

Surgical modulation of physeal growth, currently better known as "Guided Growth", is a procedure used as a treatment for length differences or axis alterations of the extremities. Although its use is increasing due to the development of new less invasive techniques, there are no statistical analyzes in the literature that support this.To evaluate the incidence of the surgery codified as "Epi- physiodesis (Femur and/or Tibia)" in the Chilean population, from January 1st, 2010 to December 31, 2019, the days of hospital stay associated with that code and the demographic data of the analyzed po pulation.We obtained from the Chilean Department of Statistics and Health Information (DEIS) database, all hospital discharges from January 1st, 2010 to December 31, 2019, from which we extracted the results with the code "Epiphysiodesis (Femur and/or Tibia)", in children under 15 years. The number of procedures per year, days of hospital stay, age, and sex were analyzed.In Chile, the number of procedures coded as "Epiphysiodesis (Femur and/or Tibia)" increa sed during the period analyzed. The days of hospital stay decreased progressively between 2012 and 2017. The procedure was performed mostly in women, and in the 5-9 years age group, showing an upward trend in children of the group of 10-14 years between 2015 and 2019.Further analysis must be carried out to determine the factors that produce these results, which are probably related to access to more efficient and simple techniques, with less morbidity.

Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population. The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears. Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined. Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus. Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears. Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus.Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023

La modulación quirúrgica del crecimiento fisiario, más conocida actualmente como “Crecimiento Guiado”, es un procedimiento utilizado como tratamiento para las diferencias de longitud o alteraciones de ejes de las extremidades. Si bien su uso se considera en aumento por el desarrollo de nuevas técnicas menos invasivas, no existen análisis estadísticos en la literatura que comprueben dicha afirmación.Objetivo: Evaluar la incidencia de la cirugía codificada como “Epifisiodesis (Fémur y/o Tibia)” en la población chilena desde el 1 de enero del 2010 al 31 de diciembre del 2019, los días de estadía hospitalaria relacionada con dicho código, y los datos demográficos de la población estudiada.Pacientes y Método: Se obtuvo desde la base de datos del Departamento de Estadísticas e Información de Salud (DEIS) de Chile, todos los egresos hospitalarios desde el 1 de enero del 2010 al 31 de diciembre del 2019, desde donde se extrajeron los resultados con el código de “Epifisiodesis (Fémur y/o Tibia)”, en menores de 15 años. Se analizó el número de procedimientos por año, número de días de estadía hospitalaria, edad y sexo de los pacientes.Resultados: El número de procedimientos codificados como “Epifisiodesis (Fémur y/o Tibia)” fue en aumento en Chile, durante el período analizado. Los días de estadía hospitalaria asociados a dicho procedimiento disminuyeron de forma progresiva entre los años 2012 y 2017. El procedimiento se realizó principalmente en mujeres, y en el grupo de 5-9 años, mostrando una tendencia al alza en niños del grupo de 10-14 años entre los años 2015 y 2019.Conclusiones: Se debe realizar mayores análisis para determinar los factores que producen estos resultados, los que probablemente se relacionen a acceso a técnicas más eficaces y sencillas, con menor morbilidad.

ResumenLa picnodisostosis es una enfermedad poco común que pertenece a las displasias esqueléticas que presentan fragilidad ósea y fracturas frecuentes. Radiológicamente se caracteriza por incremento de la densidad y fragilidad óseas.ObjetivoPresentar el caso de un escolar con displasia esquelética con fracturas en hueso patológico y manejo quirúrgico.Caso clínicoEscolar de sexo femenino, con antecedente de picnodisostosis detectado en etapa preescolar. Consulta posterior a caída de bicicleta con fractura de ambos fémures que se manejan quirúrgicamente con placa de compresión bloqueada.Nivel de evidencia: IV.AbstractPycnodysostosis is a rare condition within skeletal dysplasias presenting with brittle bones and frequent fractures. Radiologically, it is characterised by increased bone density and fragility.ObjectiveTo present the case of a primary schoolchild with skeletal dysplasia with pathological bone fractures and their surgical management.Case reportA female primary schoolchild with a history of pycnodysostosis detected during the pre-school period. She was seen after bicycle fall that resulted in the fracture of both femurs, that were surgically managed with a locking compression plate.Level of evidence: IV