The document discusses physeal injuries primarily affecting children and adolescents, detailing their types, causes, and management. Physeal injuries account for 10-15% of childhood fractures, with diagnosis focused on radiographic patterns and treatment varying based on the type of fracture. Complications from untreated physeal injuries may include growth disturbances and deformities.

1. Group : D 2015
Supervised by: ‫سعيد‬‫الدبعي‬ ‫د‬|
‫د‬|‫غازي‬‫العريقي‬

2. Approachintroduction
Who gets
physis
injuries
Causes of
physis
injuries
Diagnosis
classification
management
complication

3. Introduction
• Types of
bones

4. Introduction
longbones
A typical long bone consists of :
- Epiphysis
distal to the physis
(growth plate )
-Metaphysis
on the opposite side
of the physis from the epiphysis
-Diaphysis
is the long shaft beyond
the metaphysis

7. physealanatomy
• The growth plate (physis) is translucent ,
cartilaginous disk separating the epiphysis
from the metaphysis .
and is responsible for longitudinal growth of
long bones
• The physis is the weakest area of the growing
skeleton , weaker than the nearby ligaments
and tendons

8. Development
 Epiphysis develop from secondary centres
of ossification
 They develop by process of enchondral
ossification

10. Physeal anatomy
• The cells of the physis are arranged in layers or
zones described as :
- Germinal or resting zone
- the proliferative zone
(metotic chondrocytes
most metabolically active zone )
-Hypertrophic zone
is the weakest because it lacks
both collagen and calcified tissue
- provisional calcification zone

12. Whogetsphysisinjuries?
• these injuries occur in children and adolescents .
• Injuries to the physis are # .
• They comprise 10-15 % of all childhood fractures .
• Greatest incidence among 14-16 yrs boys and 11-13 yrs girls .
• Approximately , half of all physeal injuries occur in the
lower end of the radius at the wrist .
• also occur frequently in lower bones ( tibia & fibula) also can
occur in femur .
• Some injuries , if left untreated can cause permanent
damage and interfere with proper growth of the involved
limb .

13. Whogetsphysisinjuries?
• in growing child , a serious injury to a joint is more likely to
damage the growth plate than the ligaments that stabilize the
joint .

14. Mechanismofinjury
• Physeal fractures usually result from falls or traction
injuries.
• They occur mostly in road accidents and during
sporting activities or playground tumbles.
• Most commonly , # injury is direct .
• Other mechanisms include :
- Infections as osteomyelitis or septic arthritis
- disruption by tumors , cyst
- repetitive stress
- irradation

15. • any injury in a child followed by pain and
tenderness near the joint should arouse
suspicion, and x-ray examination is essential.
• Deformity is usually minimal
Diagnosis

16. By radiographic # patterns .
Can be of prognostic significance with respect to
growth disturbance potential .
Guide general TTT principles
Five types of growth plate injuries I-V .
Salter-Harrisclassification
Ofphysealinjurirs

17. •
Accounts for 6% of all physeal injuries.
• Transverse fracture through the growth plate.
• In a type I separation, the epiphysis separates from the metaphysis. The
plane of separation is horizontal and the germinal cells remain with the
epiphysis.
• When the periosteum is torn, displacement may occur. The periosteum is
usually torn on the convex side and is intact on the concave side.
Displacement is usually easily reduced by reversing the deforming forces
and these are often stable and treated by closed means.
• When the periosteum is not torn, there is no displacement and these
injuries are diagnosed by suspicion, by the sign of local tenderness and by
the normal appearance on x-ray.
• They are usually misdiagnosed as sprains because little is seen on the x-ray.
• Healing is rapid for type I fractures, within 2-3 weeks of injury and problems
are rare especially in sites such as the distal radius.
TypeI

18. Slipped Capital Femoral Epiphysis

19. • Most common type and accounts for 75% of
all physeal injuries.
• Transverse fracture through the growth plate and an oblique or vertical
fracture through the metaphysis.
• The type II injury starts as a horizontal separation (like type I) but this is
completed by exiting through the metaphysis, resulting in a triangular
fragment which varies in size.
• This is the most common type of physeal separation and is usually easily
reduced but not always easy to hold reduced, in a cast. Sometimes the torn
periosteum becomes trapped in the fracture site preventing a full reduction
by closed means. The trapped periosteum sometimes needs to be released
by open operation, especially at the ankle.
TypeII

20. Type II

21. • Accounts for 8% of all physeal injuries.
• Transverse fracture through the growth plate and a vertical fracture through
the epiphysis.
• Type III injuries are more commonly seen in older children where the
growth plates have started to close. It is a combination of a horizontal
fracture line through the physis and a vertical fracture line which runs from
the growth plate through the epiphysis to the articular surface.
• Displaced injuries may result in a physeal bar, leading to growth disturbance
and joint incongruity, leading to arthritis.
• Most displaced type III injuries require open reduction internal fixation
(ORIF).
TypeIII

22. Type III

23. • Accounts for 10% of all physeal injuries.
• Vertical fracture through all three components, metaphysis, physis and
epiphysis.
• These fractures are liable to displacement and a consequent misfit between
the separated parts of the physis, resulting in asymmetrical growth
• In type IV separations, the fracture line is vertical. It extends through four
distinct tissues/areas: metaphyseal bone, physeal cartilage, epiphyseal
bone or cartilage and articular cartilage.
• The most common example of a type IV physeal injury is separation of the
lateral condyle of the distal humerus.
• The four injured tissues must be accurately reduced and lined up with each
other, to minimise the risk of a physeal bar and articular incongruity.
• Most displaced type IV injuries require ORIF and long-term follow-up to
detect growth disturbance.
TypeIV

24. TYPE IV

25. • A longitudinal compression injury of the physis.
• There is no visible fracture but the growth plate is
crushed and this may result in growth arrest.
• This injury is rare and difficult to see on x-ray.
• Compression fracture or crushing of the growth plate.
• These injuries are almost always diagnosed retrospectively, when a growth
arrest has occurred.
TypeV

26. Type V

27. Management
A) Undisplaced fractures :
- treated by splinting the part in a cast or a close-fitting plaster slab
for 2–4 weeks .
- However, with undisplaced types 3 and 4 fractures, a check x-ray
after 4 days and again at about 10 days is mandatory in order not to
miss late displacement

28. Management
B ) displaced fractures :
- should be reduced as soon as possible.
- With types 1 and 2 this can usually be done closed;
the part is then splinted securely for 3–6 weeks.
- Types 3 and 4 fractures demand perfect anatomical reduction BY
open reduction and internal fixation with smooth K-wires is
essential. The limb is then splinted for 4–6 weeks .
• Types 5 and 6 fractures cause premature fusion and retardation of growth. The size
• and position of the bony bridge across the physis can
• be assessed by tomography or magnetic resonance
• imaging (MRI). If the bridge is relatively small (less
• than one-third the width of the physis) it can be
• excised and replaced by a fat graft, with some prospect
• of preventing or diminishing the growth disturbance

29. Management
B ) displaced fractures :
- Types 5 and 6 fractures cause
premature fusion and retardation of growth. The size
and position of the bony bridge across the physis can
be assessed by tomography or magnetic resonance
imaging (MRI). If the bridge is relatively small (less
than one-third the width of the physis) it can be
excised and replaced by a fat graft, with some prospect
of preventing or diminishing the growth disturbance
If the bone bridge is more extensive the operation is contraindicated
as it can end up doing more harm than good.

30. complications
• The majority of physeal injuries heal quickly and
recover fully.
• In a minority, growth disturbance or arrest may
occur, and can result in deformity and impaired
function.
Physeal growth may be disturbed by:
- Avascular necrosis
- Direct crushing (Salter-Harris type V)
- The formation of a bony bar
- Non-union
- Hyperaemia

31. complications

32. ‫الستار‬ ‫عبد‬ ‫محمد‬