Unrecognized injury of the physis in neurologically impaired children,
followed by repetitive trauma due to lack of sensation, results in a
bizarre roentgenographic appearance which may resemble that of
osteomyelitis or a malignant tumor (sarcoma or leukemia). The prolonged
process of injury and repair in the injured physis and adjacent metaphysis
is similar to that seen in Charcot neuroarthropathy. Lack of awareness of
these roentgenographic features resulted in unnecessary diagnostic biopsy
in two of the nine patients with such fractures reported in this study.
Delayed healing is characteristic of this lesion and is a result of
inadequate immobilization and failure to restrict weight-bearing. Premature
closure of the physis occurred in five of nine patients. Early recognition
and adequate immobilization allow more normal healing of this unusual
injury.