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Physeal Fractures
KEY FACTS
Terminology
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Fracture of immature skeleton involving cartilaginous primary growth plate (physis)
Imaging
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Most fractures detected & managed by radiographs alone
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Widening or interruption of normally uniform undulating lucent physis
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Translation &/or angulation of bony fragment adjacent to physis with overlying soft tissue swelling
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Persistent physeal widening > 3 mm post reduction suggests tissue entrapment requiring open reduction
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CT: Helps evaluate comminution, displacement, articular surface “step-off,” loose intraarticular fragment(s)
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MR: Can detect nondisplaced fractures, assess cartilaginous & soft tissue injury or entrapment
Top Differential Diagnoses
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Incomplete fracture
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Chronic physeal stress injury
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Rickets
Clinical Issues
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Peak age: 11-12 years
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6-30% of childhood fractures involve physis
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Overall complication rate: ∼ 14% (but varies by site)
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Premature physeal closure with limb shortening or angulation; risk highest in distal femur, tibia
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Joint incongruity due to intraarticular extension with > 2-mm articular surface gap → degenerative arthritis
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Osteomyelitis (particularly with nailbed injury)
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Diagnostic Checklist
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Always evaluate involved growth plate for premature closure on follow-up studies
Graphic shows the relationship of the epiphyseal, physeal, & metaphyseal components of the 5 main types of Salter-Harris (SH) fractures.
Lateral (left) & PA (right) radiographs of the wrist in a 9 year old show a SH II fracture of the distal radius with ∼ 60% dorsal translation of the epiphyseal
& metaphyseal
fracture fragments with ∼ 45° apex volar angulation. Note the uncovering of the volar metaphysis
. A nondisplaced ulnar styloid fracture
is noted.
& metaphyseal fracture fragments with ∼ 45° apex volar angulation. Note the uncovering of the volar metaphysis . A nondisplaced ulnar styloid fracture is noted.
Lateral (left) & AP (right) radiographs of the ankle in a 15 year old show a classic SH IV triplane fracture with sagittal epiphyseal
, horizontal physeal
, & coronal metaphyseal & diaphyseal
components. A fibular fracture
is also present.
, horizontal physeal , & coronal metaphyseal & diaphyseal components. A fibular fracture is also present.
Lateral radiograph in a 10 year old after a toe stubbing injury shows a subtle, nondisplaced SH II fracture
of the great toe distal phalanx. If there is a nailbed injury, the patient should be given prophylactic antibiotics to prevent osteomyelitis.
of the great toe distal phalanx. If there is a nailbed injury, the patient should be given prophylactic antibiotics to prevent osteomyelitis.
TERMINOLOGY
Synonyms
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Salter-Harris (SH) fractures 1-5 (I-V)
Definitions
-
Fracture of immature skeleton involving cartilaginous primary growth plate (physis)
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