Background: Neurogenic physiolysis is the spontaneous widening, inflammation, and fracture of long bone physes in children with spinal cord defects. This condition is also referred to as epiphysiolysis and is often missed by parents and physicians alike due to the lack of typical fracture symptoms like pain and deformity.

Case Presentation: We present the case of a 5-year-old lumbarlevel myelomeningocele patient who presented to the emergency department with edema, warmth, and erythema of the knee joint, and was later found to have elevated inflammatory markers concerning for infection. After a thorough workup helped to rule out infection and other life-threatening illness, the patient was successfully treated for physiolysis of the distal femur with cast immobilization.

Conclusions: General pediatricians and orthopaedic specialists should remain vigilant in recognizing physiolysis in this patient population. Missed or delayed diagnosis may lead to iatrogenic harm and can have negative long-term effects on patient’s physical development and independence.