3. OverView
- Above 10% ( 15-20%)
• Hypertrophic or calcified layer of growth plate
• often veering off into metaphysis at one of
edges to include a triangular lip of bone
• little effect on longitudinal growth, which takes place in
germinal and proliferating layers of physis
• fracture traverses cellular ‘reproductive’ layers of physis,
result in premature ossification of injured part and serious
disturbances of bone growth.
4.
5. Classification
Salter and Harris (Salter and
Harris, 1963)
Type 1
• A transverse # through hypertrophic or calcified
zone
• Even if fracture is quite alarmingly displaced,
growing zone of physis is usually not injured &
growth disturbance is uncommon.
• Prognosis excellent
6. Type 2
- similar to type 1
- Most common type
- but towards edge fracture deviates away from
physis & splits off a triangular metaphyseal
fragment of bone ( Thurston– Holland fragment).
- Prognosis Excellent
7. Type 3
A fracture that splits epiphysis & then veers off
transversely to one or other side through
hypertrophic layer .
• Inevitably it damages ‘reproductive’ layers of
physis & may result in growth disturbance.
• Good but for intra-articular
deformity need ORIF
8. Type 4
• fracture splits epiphysis, but it extends into
metaphysis.
• liable to displacement & a consequent misfit
between separated parts of physis, resulting in
asymmetrical growth.
• Good but unstable need ORIF
9. Type 5
• A longitudinal compression injury of physis.
• There is no visible fracture but G.P is crushed &
may result in growth arrest
• Poor with growth arrest
10. Rang (Rang, 1969)
• added a Type 6, an injury to perichondrial ring
( peripheral zone of Ranvier), which carries a
significant risk of growth disturbance.
• Diagnosis is made usually in retrospect after
development of deformity.
• Good but may cause angular
deformity
12. Mechanism of injury
• Falls or traction
• They occur mostly in road accidents and
during sporting activities or playground
tumbles.
13. Clinical features
• Boy > Girl 2:1
• Infancy or age 10-12 years
• Defomity usually minimal
• Any injury in a child followed by pain and
tenderness near joint should arouse suspicion,
x-ray examination is essential.
14. X ray
• physis itself is radiolucent & epiphysis may be
incompletely ossified
• makes it hard to tell whether bone end is damaged
or deformed
• Don’t Hesitate to comparison with normal side
• Telltale features are widening of physeal ‘gap’,
incongruity of joint or tilting of epiphyseal axis.
• .
15. • Any suspicion of a physeal fracture, a
repeat x-ray after 4 or 5 days is essential
• Types 5 and 6 injuries are usually
diagnosed only in retrospect
17. Displaced
• should be reduced as soon as possible
• types 1& 2 this can usually be done closed; then
splinted securely for 3–6 weeks.
• Types 3 and 4 fractures demand perfect anatomical
reduction.
• An attempt can be made by gentle manipulation
UGA; if successful, limb is held in a cast for 4–8
weeks (longer periods for type 4)
• If not immediate ORIF
18.
19. Complication
• Types 1 & 2
if properly reduced, have an excellent prognosis and
bone growth is not adversely affected
• Exceptions to this rule are injuries around knee
distal femoral or proximal tibial physis (undulating
Growth plate)
• Complications Such as malunion or non-union may
oocure.
20. • Types 3 and 4 injuries may result in
premature fusion of part of G.P or
asymmetrical growth of bone end
• Types 5 and 6 fractures cause premature
fusion & retardation of growth.
21. • Size and position of bony bridge across physis can
be assessed by tomography or (MRI).
• If bridge is relatively small (less than one-third
width of physis) it can be excised and replaced by a
fat graft, with some prospect of preventing or
diminishing growth disturbance (Langenskiold,
1975; 1981).
• But if bone bridge is more extensive operation is
contraindicated as it can end up doing more Harm
than good.
23. • Never try aggressive manipulation
• Don’t hesitate to compare with
normal side by X ray
• Follow up not mean under
confidance
Take Home Message
24. Reference
• Apleys
(System of orthopedic and fractures)
Ninth edition
• Langenskiold A. An operation for partial closure of an epiphysial plate in children, and
its experimental basis. J Bone Joint Surg 1975; 57B:325–30.
• Langenskiold A. Surgical treatment of partial closure of the growth plate. J Pediatr
Orthop 1981; 1: 3–11.
• Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg 1963; 45A: 587–
622.
• Campbells (operative orthopedics )(12th
Edition)
• Miller Review of Orthopedic (Sixth Edition)
• Pediatric orthopedic Secret (3rd
Edition)
Editor's Notes
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
In this lecture, we will go over indications for the use of the external fixator, advantages and disadvantages of its use, the mechanics of the fixator, the biology involved which includes modes of fixation, type of healing and anatomic considerations during external fixator application. We will end this talk by considering some of the historic and real complications associated with the use of the exfix device.
