Physeal Fractures | Ellen Dean-Davis, MD

Growth Plate Injuries in Young Kids

The speaker discusses growth plate injuries in young kids, including growth plate anatomy, classification of injuries, and specific examples of common and challenging injuries. The speaker also covers remodeling potential and growth potential in children.

Understanding Growth Plates

• The shaft of the bone is called the diaphysis, the ends are called the epiphysis, and where they meet is called the metaphysis.

• Growth plates are located on either end of bones and close at different ages for boys and girls.

• Most growth plate injuries occur during periods of rapid growth when kids are growing really fast.

• In upper extremities, most growth occurs proximal and distal to the bone (shoulder and wrist), while in lower extremities most growth occurs around the knee.

Classification of Injuries

• Salter Harris classification is used to classify fractures based on how they affect the growth plate.

• Type 1: Fracture goes straight across or shears the growth plate

• Type 2: Fracture goes through the growth plate and then propagates through metaphysis or above

• Type 3: Fracture goes through the growth plate and then propagates down into joint/epiphysis

• Type 4: Fracture goes through metaphysis, crosses growth plate, and into joint/epiphysis

• Type 5: Crush injury from an axial load

Specific Examples of Injuries

Proximal Humerus

• Displaced fractures have a higher risk for long-term problems.

Distal Radius

• Buckle fractures can be treated with a cast.

• Greenstick fractures may require surgery.

Tibia

• Growth plate injuries in the tibia can lead to leg length discrepancies.

• Fractures near the ankle joint can affect ankle growth.

Ankle

• Injuries to the medial malleolus can affect ankle stability and require surgery.

Remodeling Potential and Growth Potential

• The more displaced a fracture is, the worse it is and the higher the risk for long-term problems.

• Remodeling potential varies depending on age and location of injury.

Proximal Humerus Fractures

This section discusses the treatment of proximal humerus fractures in children.

Conservative Treatment for Children Under 10

• Most proximal humerus fractures can be treated conservatively without surgery if the child is under 10 years old.

• A cast may be used, but often little intervention is needed.

Surgery for Older Children

• As children get older and there is less time for growth, surgery may be necessary to line up the fracture and hold it together with pins.

• Pins are typically removed after four weeks and shoulder movement can begin soon after. Full recovery usually takes three to four months.

Distal Radius Fractures

This section discusses distal radius fractures in children.

Causes and Symptoms

• Distal radius fractures are usually caused by a fall onto an outstretched hand and occur more frequently in girls due to their earlier maturation.

• The fracture often results in significant swelling and deformity of the wrist area.

Treatment

• If caught early, most distal radius fractures can be treated by simply pushing the bone back into place and putting on a cast or brace for about four weeks.

• However, if not treated quickly or properly, complications such as compartment syndrome or further injury can arise.

Small Finger Fractures

This section discusses small finger fractures in children.

Extra Octave Fracture

• Small finger fractures are also known as Salter Harris two fractures of the proximal phalanx that occur most often in sports when the finger gets caught on a jersey and pulled to the side.

• These fractures are called "extra octave" fractures because they can limit piano playing ability.

Treatment

• Treatment for small finger fractures typically involves immobilization with a splint or cast for several weeks.

Fractures in the Lower Extremity

In this section, the speaker discusses different types of fractures in the lower extremity and their treatment.

Growth Plate Fractures

• Distal femur or proximal tibia growth plate fractures are common with football and trampolines.

• Patients present with inability to bear weight, knee held in flexion, and swelling.

• Vascular injury is a concern due to the location of the popliteal artery in relation to these growth plates.

• Compartment syndrome is also a risk.

• Most of these fractures require surgery because putting them into a cast acutely can be dangerous.

Tibial Tubercle Fracture

• Quadriceps muscle contraction forcefully on the tibial tubercle can cause an apophyseal fracture.

• This type of fracture is commonly seen in basketball players.

• There is a high rate of compartment syndrome due to the anterior artery lying over the top of the spike of the tibial tubercle.

• Urgent surgery is required, usually within several hours.

Summary

The speaker summarizes key points about physical injuries that will help guide treatment.

• Understanding certain principles about physical injuries will help guide treatment based on how much growth remains, what growth plate it is, and how bad the fracture was.

• Lower extremity fractures have a higher risk of needing more intervention down the line because they have more problems.

• Surgical intervention for lower extremity fractures may require deformity correction surgery later on.

• Patients with tibial tubercle fractures usually return to play four months after injury.

Adverse Effects on Growth Site

In this section, the speaker discusses how the growth site is adversely affected in the long term.

Growth Site Affected

• The growth site is adversely affected in the long term.

Conclusion

In this section, the speaker concludes their statement.

Thanks

• Speaker thanks someone.