physeal injuries kakwani. introduction introduction the physis the physis classification of physeal...

Physeal injuriesPhyseal injuries

KakwaniKakwani

IntroductionIntroduction The physisThe physis Classification of physeal injuriesClassification of physeal injuries Principles of managementPrinciples of management

IntroductionIntroduction

Skeletal trauma: 10-15 % Skeletal trauma: 10-15 % Physeal disruptions : 30 % Physeal disruptions : 30 % Male : Female = 2 : 1Male : Female = 2 : 1 54% : Salter-Harris II54% : Salter-Harris II < 2 yr old consider NAI< 2 yr old consider NAI

Robert SalterRobert Salter

B.1924, CanadaB.1924, Canada Pioneered Pioneered

development of development of children's children's orthopaedic orthopaedic surgery.surgery.

Surgeon-in-Chief, Surgeon-in-Chief, Hospital for Sick Hospital for Sick Children Children

W. Robert Harris

1922–2005 Professor: Division of

Orthopaedic Surgery, University of Toronto

President of the Canadian Orthopaedic Foundation

Mercer RangMercer Rang

1933 -2003, b. London1933 -2003, b. London Graduated UCHGraduated UCH Wrote many books on Wrote many books on

children's fractureschildren's fractures Staff of Hospital for Staff of Hospital for

Sick ChildrenSick Children

0

5

10

15

20

25

Distal

Radius

Hand

Tibia

Elbow

Clavicle

Foot

Humerus

Femur

Other

Incidence of specific fracture types (%)

Epiphyseal blood supplyEpiphyseal blood supply

Physeal traumaPhyseal trauma

Rotation/ ShearRotation/ Shear Low velocityLow velocity OccultOccult Rapid healing - < 3 weeksRapid healing - < 3 weeks Relevance decreases with age.Relevance decreases with age.

ClassificationsClassifications

PolandPoland 18981898

Salter - Salter - HarrisHarris

19631963

AitkenAitken 19651965

RangRang 19691969

WeberWeber 19801980

Ogden Ogden 19811981

PetersonPeterson 1994 1994

Type 1Type 1

Type 2Type 2

Type 3Type 3

Type 4Type 4

Type VType V

Deformities following Type 5Deformities following Type 5

Type VIType VI

Added by Rang Added by Rang (1969)(1969)

Apophyseal injuriesApophyseal injuries

Principles of managementPrinciples of management

DiagnosisDiagnosis GoalsGoals

ReductionReduction Avoid growth plate arrestAvoid growth plate arrest Return of function Return of function

Operative or non-operativeOperative or non-operative

Principles of managementPrinciples of management

Diagnosis:Diagnosis: Index of suspicionIndex of suspicion Contralateral x-raysContralateral x-rays CTCT

Principles of managementPrinciples of management

GoalsGoals ReductionReduction Avoid growth plate injuryAvoid growth plate injury Return of function Return of function

Principles of managementPrinciples of management

Non-operative Non-operative treatment:treatment: Types I & IITypes I & II TimingTiming Manipulation vv Manipulation vv

tractiontraction Acceptable deformityAcceptable deformity Remodeling potentialRemodeling potential

Principles of managementPrinciples of management

Operative treatment:Operative treatment: Types III & IVTypes III & IV Periosteal interposition Periosteal interposition

(type II)(type II) TimingTiming Crossing the growth plateCrossing the growth plate Remodeling potentialRemodeling potential

Questions ???Questions ???

ReferencesReferences

ReferencesReferences RB Salter, WR Harris. Injuries involving the RB Salter, WR Harris. Injuries involving the

eiphyseal plate. JBJS Vol 45. 1963. p 587-632. eiphyseal plate. JBJS Vol 45. 1963. p 587-632. Physeal Arrest. Ogden-John-A. The Journal of Bone Physeal Arrest. Ogden-John-A. The Journal of Bone

and Joint Surgery (American Volume). 1987 Oct. and Joint Surgery (American Volume). 1987 Oct. 69-A(8). pp 1297-1302. 69-A(8). pp 1297-1302.

Injuries of the epiphyseal plate. RBSalter. Injuries of the epiphyseal plate. RBSalter. Instructional Course Lectures. Vol 41. 1992. p 351-Instructional Course Lectures. Vol 41. 1992. p 351-359. 359.

Peterson.J. Physeal Fractures. Part 3. Peterson.J. Physeal Fractures. Part 3. Classification.J Pediatric Orthopedics. Vol 14(4). Classification.J Pediatric Orthopedics. Vol 14(4). 1994. p 439-448 1994. p 439-448

Green: Skeletal Trauma in Children 3Green: Skeletal Trauma in Children 3rdrd ed. ed. Elseiver. 2003.Elseiver. 2003.

Robert B. Salter: Disorders and Injuries of the Robert B. Salter: Disorders and Injuries of the Musculoskeletal System, 3rd Edition., Baltimore, Musculoskeletal System, 3rd Edition., Baltimore, Williams and Wilkins, 1999Williams and Wilkins, 1999

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