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Physeal injuriesPhyseal injuries
KakwaniKakwani
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IntroductionIntroduction The physisThe physis Classification of physeal injuriesClassification of physeal injuries Principles of managementPrinciples of management
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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
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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
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W. Robert Harris
1922–2005 Professor: Division of
Orthopaedic Surgery, University of Toronto
President of the Canadian Orthopaedic Foundation
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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
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0
5
10
15
20
25
Distal
Radius
Hand
Tibia
Elbow
Clavicle
Foot
Humerus
Femur
Other
Incidence of specific fracture types (%)
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Epiphyseal blood supplyEpiphyseal blood supply
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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.
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ClassificationsClassifications
PolandPoland 18981898
Salter - Salter - HarrisHarris
19631963
AitkenAitken 19651965
RangRang 19691969
WeberWeber 19801980
Ogden Ogden 19811981
PetersonPeterson 1994 1994
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Type 1Type 1
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Type 2Type 2
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Type 3Type 3
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Type 4Type 4
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Type VType V
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Deformities following Type 5Deformities following Type 5
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Type VIType VI
Added by Rang Added by Rang (1969)(1969)
Apophyseal injuriesApophyseal injuries
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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
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Principles of managementPrinciples of management
Diagnosis:Diagnosis: Index of suspicionIndex of suspicion Contralateral x-raysContralateral x-rays CTCT
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Principles of managementPrinciples of management
GoalsGoals ReductionReduction Avoid growth plate injuryAvoid growth plate injury Return of function Return of function
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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
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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
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Questions ???Questions ???
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ReferencesReferences
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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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