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Physeal injuriesPhyseal injuries
KakwaniKakwani
IntroductionIntroduction The physisThe physis Classification of physeal injuriesClassification of physeal injuries Principles of managementPrinciples of management
IntroductionIntroduction
Skeletal trauma: 10-15 % Skeletal trauma: 10-15 % Physeal disruptions : 30 % Physeal disruptions : 30 % Male : Female = 2 : 1Male : Female = 2 : 1 54% : Salter-Harris II54% : Salter-Harris II < 2 yr old consider NAI< 2 yr old consider NAI
Robert SalterRobert Salter
B.1924, CanadaB.1924, Canada Pioneered Pioneered
development of development of children's children's orthopaedic orthopaedic surgery.surgery.
Surgeon-in-Chief, Surgeon-in-Chief, Hospital for Sick Hospital for Sick Children Children
W. Robert Harris
1922–2005 Professor: Division of
Orthopaedic Surgery, University of Toronto
President of the Canadian Orthopaedic Foundation
Mercer RangMercer Rang
1933 -2003, b. London1933 -2003, b. London Graduated UCHGraduated UCH Wrote many books on Wrote many books on
children's fractureschildren's fractures Staff of Hospital for Staff of Hospital for
Sick ChildrenSick Children
0
5
10
15
20
25
Distal
Radius
Hand
Tibia
Elbow
Clavicle
Foot
Humerus
Femur
Other
Incidence of specific fracture types (%)
Epiphyseal blood supplyEpiphyseal blood supply
Physeal traumaPhyseal trauma
Rotation/ ShearRotation/ Shear Low velocityLow velocity OccultOccult Rapid healing - < 3 weeksRapid healing - < 3 weeks Relevance decreases with age.Relevance decreases with age.
ClassificationsClassifications
PolandPoland 18981898
Salter - Salter - HarrisHarris
19631963
AitkenAitken 19651965
RangRang 19691969
WeberWeber 19801980
Ogden Ogden 19811981
PetersonPeterson 1994 1994
Type 1Type 1
Type 2Type 2
Type 3Type 3
Type 4Type 4
Type VType V
Deformities following Type 5Deformities following Type 5
Type VIType VI
Added by Rang Added by Rang (1969)(1969)
Apophyseal injuriesApophyseal injuries
Principles of managementPrinciples of management
DiagnosisDiagnosis GoalsGoals
ReductionReduction Avoid growth plate arrestAvoid growth plate arrest Return of function Return of function
Operative or non-operativeOperative or non-operative
Principles of managementPrinciples of management
Diagnosis:Diagnosis: Index of suspicionIndex of suspicion Contralateral x-raysContralateral x-rays CTCT
Principles of managementPrinciples of management
GoalsGoals ReductionReduction Avoid growth plate injuryAvoid growth plate injury Return of function Return of function
Principles of managementPrinciples of management
Non-operative Non-operative treatment:treatment: Types I & IITypes I & II TimingTiming Manipulation vv Manipulation vv
tractiontraction Acceptable deformityAcceptable deformity Remodeling potentialRemodeling potential
Principles of managementPrinciples of management
Operative treatment:Operative treatment: Types III & IVTypes III & IV Periosteal interposition Periosteal interposition
(type II)(type II) TimingTiming Crossing the growth plateCrossing the growth plate Remodeling potentialRemodeling potential
Questions ???Questions ???
ReferencesReferences
ReferencesReferences RB Salter, WR Harris. Injuries involving the RB Salter, WR Harris. Injuries involving the
eiphyseal plate. JBJS Vol 45. 1963. p 587-632. eiphyseal plate. JBJS Vol 45. 1963. p 587-632. Physeal Arrest. Ogden-John-A. The Journal of Bone Physeal Arrest. Ogden-John-A. The Journal of Bone
and Joint Surgery (American Volume). 1987 Oct. and Joint Surgery (American Volume). 1987 Oct. 69-A(8). pp 1297-1302. 69-A(8). pp 1297-1302.
Injuries of the epiphyseal plate. RBSalter. Injuries of the epiphyseal plate. RBSalter. Instructional Course Lectures. Vol 41. 1992. p 351-Instructional Course Lectures. Vol 41. 1992. p 351-359. 359.
Peterson.J. Physeal Fractures. Part 3. Peterson.J. Physeal Fractures. Part 3. Classification.J Pediatric Orthopedics. Vol 14(4). Classification.J Pediatric Orthopedics. Vol 14(4). 1994. p 439-448 1994. p 439-448
Green: Skeletal Trauma in Children 3Green: Skeletal Trauma in Children 3rdrd ed. ed. Elseiver. 2003.Elseiver. 2003.
Robert B. Salter: Disorders and Injuries of the Robert B. Salter: Disorders and Injuries of the Musculoskeletal System, 3rd Edition., Baltimore, Musculoskeletal System, 3rd Edition., Baltimore, Williams and Wilkins, 1999Williams and Wilkins, 1999
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