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Physeal Injuries: Dr. Bassey, A E Orthopaedic & Trauma Surgery U.A.T.H, Abuja
Physeal Injuries: Dr. Bassey, A E Orthopaedic & Trauma Surgery U.A.T.H, Abuja
DR. BASSEY, A E
ORTHOPAEDIC & TRAUMA SURGERY
U.A.T.H, ABUJA
OUTLINE
• INTRODUCTION
DEFINITION
STATEMENT OF IMPORTANCE
EPIDEMIOLOGY
• ANATOMY OF THE PHYSIS
• AETIOPATHOGENESIS OF PHYSEAL INJURIES
• CLASSIFICATION
• MANAGEMENT
HISTORY
EXAMINATION
INVESTIGATION
TREATMENT
• COMPLICATIONS
• FOLLOW-UP/REHABILITATION
• PROGNOSIS
• CURRENT TRENDS
• CONCLUSION
INTRODUCTION
• DEFINITION - PHYSEAL INJURY IS A
DISRUPTION IN THE CARTILAGINOUS PHYSIS
OF LONG BONES THAT MAY INVOLVE
EPIPHYSEAL AND/OR METAPHYSEAL BONE
• X-RAYS
WIDENING OF PHYSEAL GAP
JOINT INCONGRUITY
TILTING OF EPIPHYSIS
PRESENCE OF DISPLACEMENT MAKES
DIAGNOSIS MORE OBVIOUS
TYPES 5 & 6 INJURIES ARE USUALLY
DIAGNOSED RETROSPECTIVELY
X-RAY FINDINGS IN PHYSEAL INJURY – NORMAL
PHYSIS
SALTER HARRIS TYPE 1
SALTER HARRIS TYPE 2
SALTER HARRIS TYPE 2
SALTER HARRIS TYPE 3
SALTER HARRIS TYPE 4
INVESTIGATION
• CT
TO VISUALISE FRACTURE ANATOMY IN SEVERELY
COMMINUTED FRACTURES OF EPIPHYSIS AND
METAPHYSIS
• MRI
MOST ACCURATE FOR FRACTURE ANATOMY IF DONE IN
ACUTE PERIOD
IDENTIFIES FORMATION OF BONY BRIDGE EARLIER
THAN X-RAYS
TREATMENT
• DEPENDS ON THE FOLLOWING FACTORS
TYPE OF INJURY
AGE OF PATIENT
FRACTURE STABILITY
• FOR TYPES 1 & 2
CLOSED REDUCTION AND IMMOBILIZATION IN
CAST WILL USUALLY SUFFICE
CHECK X-RAY IN 7 – 10 DAYS
• FOR TYPES 3 & 4
REQUIRE ANATOMICAL REALIGNMENT VIA ORIF
ORIF CAN BE WITH LAG SCREWS OR KIRSCHNER
WIRES RUNNING PARALLEL TO PHYSIS
• FOR TYPES 5 & 6
USUALLY DIAGNOSED RETROSPECTIVELY
HOWEVER HIGH INDEX OF SUSPICION MUST BE
MAINTAINED IN HIGH RISK INJURIES
COMPLICATIONS
• GROWTH ARREST
OCCURS BY DISRUPTION OF PHYSEAL BLOOD
SUPPLY OR BONE BRIDGE FORMATION
MAY BE PARTIAL OR COMPLETE
• GROWTH ACCELERATION
• SECONDARY OSTEOARTHRITIS
FOLLOW-UP/REHABILITATION
• TYPE OF INJURY
• EXTENT OF CHONDRO-OSSEOUS
DISRUPTION
CURRENT TRENDS
• GROWTH PLATE INTERPOSITION
FAT
BONE WAX
SILICON RUBBER
POLYMETHYLMETHACRYLATE
LABORATORY-DERIVED CHONDROCYTE
ALLOGRAFT
YOU
REFERENCES
• Nayagam S. Principles of Fractures. In: Solomon L,
Warwick D, Nayagam S. Apley’s System of Orthopaedics
& Fractures. 9th ed. Hodder Arnold;2010: 727 – 730.
• Mann DC, Rajmaira S. Distribution of physeal and non-
physeal fractures in 2,650 long-bone fractures in
children aged 0-16 years. J Pediatr Orthop. Nov-Dec
1990;10(6):713-6.
• Neer CS, Horowitz BS. Fractures of the proximal
humeral epiphyseal plate. Clin Orthop Rel Res.
1965;41:24-31.
• http://emedicine.medscape.com/article/1260663-overview
• http://www.wheelessonline.com/ortho/growth_plate_anatom
• http://www.orthobullets.com/pediatrics/4002/physeal-consi