Published on March 16, 2014
PHYSEAL INJURIES Dr . LOKESH SHAROFF Orthopaedic surgeon, mumbai, india
ANATOMY OF PHYSIS GERMINAL LAYER ZONE OF PROLIFERATING CARTILAGE ZONE OF HYPERTROPHIC CELLS ZONE OF PROVISIONAL CALCIFICATION ZONE OF ENCHONDRAL OSSIFICATION
CLASSIFICATIONS AITKENS (1936) SALTER&HARRIS(1963) OGDEN(1981) PETERSON(1994)
SH TYPE 1 Complete seperation of epiphysis without true # through bone with or without displacement From shearng/torsion/avulsion No findings on x-ray Good prognosis
SH TYPE 2 # seperation line traverses along physis to a variable distance & then out through a portion of triangular shaped metaphyseal fragment(Thurstan-Holland sign) Intact periosteum on the side of metaphyseal fragment Prognosis-good
SH TYPE 3 Vertical split from joint surface to physis & then along physis to periphery(intra-articular) Uncommon Lower tibial epiphysis Prognosis-good
SH TYPE 4 Intra-articular # extending from joint surface through epiphysis,entire physis & a portion of metaphysis -Lateral condyle of humerus Prognosis-bad
S H TYPE5 Severe crushing force applied through epiphysis damaging the germinal layer of physis No osseous injury -diagnosed in retrospect
S H TYPE 6 Perichondrial injury as described by Mercer Rang(1969) Rare injury Blow to periosteum/perichondrial ring scarring tethering and bony bar formation can occur
OGDEN 7 INTRA-ARTICULAR OSTEOCHONDRAL FRACTURE
OGDEN 8 AND 9 METAPHYSEAL AND DIAPHYSEAL #S RESPECTIVELY BUT SEEN TO STIMULATE THE LONGITUDINAL GROWTH OF THAT BONE.
PETERSON He described 2 new types of fractures .. 1st and 5th in his classification
PETERSON TYPE1 Transverse # of metaphysis with # line extending to physis Comminution-common MOI:longitudinal compression Sites:distal radius,finger phalanges,MC Prognosis:good
PETERSON TYPE 2 Seperation of physis with a portion of metaphysis attached to epiphysis (THURSTAN-HOLLAND sign) Most common type Site:finger phalanges
PETERSON TYPE 3 Seperation of metaphyis from epiphysis through the physis disrupting the physis Site:distal fibula
PETERSON TYPE 4 # of epiphysis extending to & along the physis May be comminuted/double Common in older children Premature growth arrest common Sites:finger phalanges,distal tibia(medial malleolus0
PETERSON TYPE 5 # that traverses the metaphysis,physis,epiphysis & atricular cartilage Tri-plane # Comminution & open# common Premature growth arrest occurs sites: lateral condyle humerus, distal tibia
PETERSON TYPE 6 # in which part of metaphysis,physis & epiphysis is removed/ missing Found in open # Premature closure of epiphysis occurs
PROGNOSIS Severity of injury Age of the child Site of injury Amount of physis injured
TREATMENT To obtain & maintain reduction by closed/open means To maintain function & normal growth
PRINCIPLES OF TREATMENT Physeal # should be reduced immediately All reductions open/closed should be gentle Forceful repeated manipulations should be avoided During open reduction pressure on physis should be avoided
PETERSON TYPE 1 CMR & casting Immobilisation for 3-4 weeks Follow up to ensure normal growth
P TYPE 2/S H TYPE 2 CMR & casting under GA/block Metaphyseal fragment & intact periosteum provide stability Surgical intervention 1.periosteal impingement 2.unstable fragment ? Bio-degradable pins
P TYPE 3/S H TYPE 1 CMR & casting
P TYPE 4/S H TYPE 3 Anatomical reduction of physeal & articular cartilage by ORIF
P TYPE 5/S H TYPE 4 OR & IF
P TYPE 6 Initial debridement followed by reconstructive surgery later on
COMPLICATIONS Premature growth arrest 1.length discrepancy 2.angular deformity Compartment syndrome/arterial occlusion Neurological complications sepsis & osteomyelitis Overgrowth & hypoplasia Malunion/delayed union/non union
HARRIS GROWTH ARREST LINES Symmetrical, thin white lines Perpendicular to long axis of bone Metaphyseal at first Most marked in rapidly growing ends of bones, e.g. distal femur and proximal tibia They migrate towards the diaphysis with further growth and may disappear
HARRIS GROWTH ARREST LINES Denote activity of physeal plate If asymmetric , denotes partial arrest If lines are absent , denotes growth arrest
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1. Clin Orthop Relat Res. 1978 Oct;(136):230-3. Physeal injuries of the ankle in children: classification. Dias LS, Tachdjian MO. Seventy-one cases of ...
Übersetzung für physical injury im Englisch-Deutsch-Wörterbuch dict.cc.
physeal pertaining to growth or to that part of a bone that is responsible for lengthening—the physis. physeal delayed closure occurs when there is ...