Post-traumatic Distal Femoral Salter-Harris Type II Fracture Unmasking an Incidental Osteochondroma as a Possible Stress Riser: A Case Report With Surgical Management

Osteochondromas are the most common benign bone tumors and are frequently discovered incidentally in the metaphyseal regions of long bones during growth. While typically asymptomatic, they may occasionally lead to complications such as neurovascular impingement, mechanical irritation, or pathological fractures. Salter-Harris type II fractures represent the most frequent physeal injuries in pediatric populations, particularly in rapidly growing regions like the distal femur. The simultaneous occurrence of a Salter-Harris type II fracture and an underlying osteochondroma at the same anatomical location is exceedingly rare. This report presents a unique case of a 15-year-old male who sustained a distal femoral physeal fracture following trauma, which revealed an incidental osteochondroma on imaging. Surgical management included open reduction and internal fixation using a distal femoral locking plate, along with excision of the osteochondroma. Histopathology confirmed a benign osteochondroma without features of malignant transformation. The case underscores the importance of comprehensive imaging in pediatric trauma, particularly when radiographs demonstrate atypical findings. The role of the osteochondroma as a biomechanical stress riser likely contributed to the fracture at this site. The dual surgical approach enabled both fracture stabilization and safe lesion excision. This case highlights the necessity of individualized, multidisciplinary management strategies in pediatric orthopedic trauma complicated by benign bone tumors and reinforces the value of considering occult skeletal anomalies in atypical fracture presentations.