Prognosis for growth is therefore excellent assuming that the blood supply remains intact.Īpproximately 8% of epiphyseal plate injuries are type III. The physis itself is again intact remaining attached to the epiphysis with the metaphyseal fragment. Reduction is easy due to the intact ‘periosteal hinge’. This is also usually due to shearing or avulsion however, the periosteum in this case is torn on the convex side of the angulation. The fracture line runs across the zone of transformation and extends into the metaphysis removing a triangular metaphyseal fragment (Thurston-Holland’s sign). Peak incidence is at an age between 10 and 16 years. This is by far the commonest form of epiphyseal plate injury, amounting to approximately 75%. Type I injuries may also be seen in the context of scurvy, rickets, osteomalacia and other endocrine abnormalities. The prognosis for future growth is excellent unless the epiphysis involved is entirely covered by cartilage (e.g. If reduction is required, this is usually not difficult due to the continuity of the periost. The periosteum is intact and the fracture may reduce immediately and therefore be difficult to spot. The germinal matrix is preserved in its entirety on the epiphyseal side. This is a result of shearing or avulsion force causing a transverse fracture of the zone of transformation. The epiphysis is completely separated from the metaphysis.
Type I injuries occur usually below the age of 5 years and may be seen in the context of birth trauma. This amounts to approximately 6% of epiphyseal plate injuries. The diagnosis of separation of an epiphysis before its ossification centre has appeared is very difficult, but this may be suspected if there is mal-alignment of the metaphysis and significant soft tissue swelling. If doubt exists comparison views of the other limb may be useful. A minimum of two views obtained at right angles to each other is essential.
Minor disturbances, which are not clinically relevant, occur more frequently. Significant disturbance of growth occurs in approximately 10% of epiphyseal plate injuries. Factors affecting the prognosis of epiphyseal plate injuries include the mechanism of this, the age of the child at the time of injury, the blood supply to the epiphysis, the method of reduction and the extent of soft tissue injury (e.g. Aitken classification used in Germany) but are not internationally recognised.Įpiphyseal plate injury should be suspected in any child with injuries to joints, be it fracture, dislocation, ligamentous rupture or even simple sprains. The most commonly used classification is the Salter-Harris classification, others have been described (e.g. Classification of epiphyseal fractures is based on the degree of involvement of the germinal matrix and allows categorisation according to the radiographic appearances as well as the prognosis. The cartilaginous matrix hypertrophies, degenerates and mineralises in the zone of transformation after which vascular penetration and osteogenesis begins and this eventually becomes the bony metaphysis. Growth of long bones is achieved by division of chondrocytes within the germinal layer of the growth plate, which proliferate towards the metaphyseal side. This is important as injuries to the growth plate may result in shortening or deformity of the growing bone.Įpiphyses consist of the epiphyseal bone plate with the articular surface and the epiphyseal growth plate. Approximately 10% of long bone injuries in patients under the age of 16 years involve the epiphyseal growth plate (physis).
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