Pediatrics Case 7 History/Physical Exam

Usually, patients with distal femoral physis fractures are unable to walk or bear weight on injured extremity. The knee is often held in flexion secondary to hamstring spasm. On exam, effusions and soft tissue swelling can also be seen.

In cases of suspected child abuse, a careful history should be obtained as well as a complete physical exam evaluating for other signs of trauma. Other fractures associated with non-accidental trauma include multiple fractures in different stages of healing, rib fractures, humeral fractures and skull fractures. When abuse is considered, a "skeletal survey" series of x rays should be ordered to seek other fractures that may have occurred from abuse.