PHYSEAL INJURY
HIL - ORTHOPAEDI
PHYSEAL INJURY
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ANATOMY
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Physis is a Greek word (phyein) which means nature, or to
generate
English medical dictionaries : the segment of bone responsible
for growth in length of the bone
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Growth patterns of a typical enchondral bone. a In addition to
longitudinal growth, the flat primary physis (PP) initially also
grows latitudinally (circumferentially). The developing secondary
center of ossification enlarges globally from its own spherical
secondary physis (SP). b Once the secondary center of ossification
(SCO) is relatively mature, latitudinal growth of the physis is
essentially appositional growth, supplied by the zone of Ranvier
(open arrows). c Bone remodeling occurs in the metaphysis by
subperiosteal osteoclasts and osteoblasts (shaded arrows)
GROWTH
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Temporary ischemia of the metaphysis impedes the enchondral
ossification process, but not growth of the germinal and columnar
layers of the physisTemporary ischemia of the epiphyseal blood
supply results in death of the germinal cells and loss of
growth
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Relative growth from each end of the major long bones. The
horizontal line represents birth. The numbers represent the final
percentage of growth supplied by each end of the bone
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CLASSIFICATION
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Comparison of comprehensive physeal classifications#16
EPIDEMIOLOGY
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Comparison of physeal fractures to total fractures in
children#
Comparison of physeal fractures: upper versus lower
extremity#
Relative frequency of physeal fractures by site, 19701990#
Distribution of physeal fractures by type (Salter-Harris
Classification)#
EVALUATION
#EVALUATION History birth fractures, child abuse, and congenital
insensitivity to pain, a fall, a sports activity, or a motor
vehicle accident. Mechanism of injury (i.e., abduction, adduction,
varus, valgus, rotation, and so forth) Physical
ExaminationLocalized pain, swelling and tenderness, ecchymosis and
muffled crepitance, joint swelling (hemarthrosis), ambulation is
restricted or not possible, Displaced fractures may exhibit limb
deformity#
ImagingTime of Appearanceof Ossification Centers and Closure of
Physes
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MANAGEMENT
#Guide to the care of the growth-plate injury
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the epiphysis separates completely from the metaphysis Usually
the result of shearing, torsion, or avulsion force Healing occurs
whitin 3 weeks Good prognosis# The plane of cleavage passes through
much of the plate before the fracture travels through the
metaphysis Produce by lateral displacement forces Usually easily
reduced If the degree of displacement is unacceptable, open
reduction maybe needed Good prognosis
# The plane of separation passes along with the growth plate for
a variable period before entering the joint through a fracture of
the epiphysis The fracture is intra articular and requires accurate
reduction Open reduction maybe needed
# The fracture line passes through from the joint surface,
across the epiphysis, growth plate, and into metaphysis The
fracture must be accurate reduced, usually by open reduction to
secure a smooth joint surface
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UncommonCommonly missedHigh index of suspicion necessaryWarn
parents of possible growth disturbances in the future#Management
Choices###
COMPLICATION
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The type, number, and percentage of complications by site in
Olmsted County, Minnesota, 19791988###REFERANCES
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TERIMA KASIH
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