PHYSEAL INJURY

PHYSEAL INJURY

 Introduction:

Growth plate injury, or injury to physeal plate in children are not uncommon. About over 10% of children fractures are involved growth plate. In children A cartilaginous plate seen between metaphysis and epiphysis, Microscopically growth plate has 4 layers-

1. Germinal layer

2. Proliferating layer

3.Hypertrophic zone

 4.Calcified layer.

Common site of injury: HYPERTROPHIC and CALCIFIED zone

 

CLASSIFICATION : Salter and Harris Classification,

 

5 basic type of injury:

 

1. Type I :A transverse fracture line  through hypertrophic or calcified zone,

Growth disturbance is uncommon.

 

2. Type II: Similar  to type 1,with fracture of metaphysis at the edge,  traingular shape(Thurston-Holland fragment).

 

 3. Type III: Similar to type 1,with fracture of epiphysis.involved hypertrophic layer,damege of reproductive layer ,growth disturbance common

 

4. Type IV: As  with type 3, fracture splits epiphysis and metaphysis, displacement common, growth disturbance also common.

 

5.Type V: Longitudinal compression injury, growth plate may be crushed and growth arrest common. 

Another one considered as type VI involved  the perichondrial ring (peripheral zone of Ranvier)

         

     Mechanism of injury:

Falls Or traction injury

common in road accident, and sports injury

Clinical feature : Common age 10 to 12 years, or in infancy

                             H/O - Trauma, with pain, swelling, near the joint .

                                        Local  tenderness, painful joint movement .

 X-Ray : 

If there is marked displacement, diagnosis is obvious, undisplaced fracture is hard to diagnose in x-ray, as physis is radiolucent and epiphysis may incompletely ossified.

         Comparison to normal  side  may help.

        Repeat x-ray after 4 to 5 days is essential if any suspicious.

        In case of type 5 and 6 ,CT ,MRI may required.

 Treatment:

Undisplaced : Splinting 2-4 weeks(according to age and site)

                                            If type 3 or 4 - X-ray at 4th and 10th day for late displaced missing.

                    Displaced :For type 1 &2 ,--- close reduction as soon as possible, and splinted for 3 to 6                                             weeks

                                        For type 3 or 4 --- Gentle manipulation under general anesthesia,for close                                                 reduction and then splinted for 4 to 8 weeks. If not reduced then go for open                                             reduction & internal fixation with smooth K Wire , & splinted for 4 to 6                                                 weeks.

Complication: 

 

Type  1 & 2 if not reduced, malunion, non union may occur, in case of type 3 or  4 -asymmetric growth  and verus or valgus deformity .In case of type 5 or  6 --Premature fusion of growth cartilage may occur, if size of fusion is less than 1/3 rd of the wide of plate .it can be excised. If large one operation contraindicated.

REF; Apply,s system of orthopedics ( p 727),Campbell,s operative ortho(p)