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  1. 1. Extern conference Ext.Jan 5422069
  2. 2. Case ▷เด็กชายไทย อายุ 10 ปี ▷Chief complaint : ปวดข้อมือขวา 1 วัน
  3. 3. Primary survey ▷Airway patent airway , no tenderness along C spine , can active neck movement all direction ▷Breathing Normal breathsound clear both lungs, CCT negative ▷Circulation BP 100 / 56 mmHg, PR 68 bpm ▷Disability E4V5M6 ,pupil 2 mm react to light both eyes ▷Exposure No external wound , tenderness and limit ROM Rt wrist
  4. 4. Secondary survey ▷Allergy no drug, no food allergy ▷Medication No current medication ▷Past illness No underlying disease ▷Last meal 12.00น.
  5. 5. Secondary survey ▷Event 1 day PTA โดนลูกฟุตบอลเตะใส่ข้อมือด้านขวา หลังจากนั้นมีอาการปวด บวมแดงที่ข้อมือขวา ขยับข้อมือไม่ได้ เมื่อขยับแล้วมีอาการปวด กระดก หรืองอข้อมือลาบาก
  6. 6. Physical examination • Vital sign BP 100 / 56 mmHg, PR 68 bpm RR 20/min Temp 36.5 ˚C • HEENT not pale conjunctiva anicteric sclera • Heart normal S1S2 no murmur • Lungs normal breathsound clear both lungs • Abdomen soft not distend not tender normoactive bowel sound
  7. 7. Physical examination ▷Extremities Mild swelling and tenderness Pain on active movement Limit ROM on Flexion and extension Rt. Wrist No external wound , no deformity Radial pulse 2+ capillary refill < 2 sec
  8. 8. Physical examination
  9. 9. Film Rt. wrist AP Lateral
  10. 10. Diagnosis ▷Epiphyseal plate injury Rt. Wrist Type I
  11. 11. Management ▷Control pain ▷Close reduction ▷On Short arm AP slap and arm sling
  12. 12. Film Rt. wrist AP Lateral (on slap)
  13. 13. Epiphyseal plate injury
  14. 14. Anatomy ▷Growth plates are found in the long bones ▷Growth plates are located between the metaphysis and the epiphysis
  15. 15. ▷15-30% of fracture in childern ▷All children who are still growing • risk for growth plate injuries • peaks in adolescence. ▷occur twice as often in boys as in girls • girls finish growing earlier than boys. Epidermiology
  16. 16. Mechanism of injury ▷Direct injury ▷Indirect injury • repetitive stress on the bone
  17. 17. Prognosis ▷ most 85% of growth plate injuries heal without complication
  18. 18. Presentation ▷Visible deformity ▷An inability to move or put pressure on the limb ▷Swelling, warmth, and tenderness
  19. 19. Salter and Harris classification
  20. 20. Salter and Harris classification ▷Type I Injuries • Due to a separation through the growth • plate of the metaphysis and diaphysis.
  21. 21. Salter and Harris classification ▷Type II Injuries • Fracture traverses physis and exits metaphysis • most common type
  22. 22. Salter and Harris classification ▷Type III Injuries • fracture traverses physis and exits epiphysis
  23. 23. Salter and Harris classification ▷Type IV Injuries • fracture passes through epiphysis, physis, metaphysis
  24. 24. Salter and Harris classification ▷Type IV Injuries • crush injury to physis
  25. 25. Management
  26. 26. Complication ▷Growth arrests • Most common in Type IV and Type V - complete arrest leads to shortening - partial arrest leads to angulation
  27. 27. Long-Term Follow-up ▷3- to 6-month intervals for at least 2 years. • make sure that the growth plate is growing appropriately.