The epiphyseal plate or epiphysial plate, physis, or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. Classification conveniently the salterharris types can b. Epiphyseal separation canbeproduced inagrowing animal byclosed manipulyseparated byinjury. The dread complication of serious disturbance of growth is usually predictable and, in certain circumstances, can be prevented. Acute and chronic growth plate injuries american academy. Occult distal femoral physeal injury with disruption of the perichondrium nancy chauvin, md and diego jaramillo, md, mph abstract. Im ed smith, a personal injury lawyer in sacramento. A thorough knowledge of functional growth plate anatomy and physiology is essential to proper management of epiphyseal foot and ankle injuries. Growth plate injuries can occur in the skeletally immature child. Experimental epiphyseal injuries areeasy toproduce.
Fractures involving the epiphyseal plate, or physis, are common musculoskeletal injuries occurring in children with open growth plates. The incidence of injury involving the epiphyseal growth plates physes of the distal humerus is unknown. Epiphyseal plate injuries in children personal injury lawyer. Premature closure of the growth plate in the distal radius or ulna did not occur in any of these children. Occult distal femoral physeal injury with disruption of the. Each title was searched manually for any focus on growth plate injuries involving the long or tubular bones of young athletes. Trauma to epiphysis chondral to osteochondral isolated injury of the epiphyseal plate type 7 ogden.
Thus, knowl edge of the prognosis for a given injury to the epiphyseal plate in a particular child. Physes may be injured in various ways, the most common of which is fracture. Growth plate histology zones of the physis germinal zone minimally active, scattered chondrocytes proliferative zone columns of chondrocytes actively dividing hypertrophic zone chondrocytes accumulate and release calcium weakest zone of physis zone of endochondral ossification. Growth plate fractures are often caused by a single event, such as a fall or car accident. If growth is arrested over part of the epiphyseal plate only, there will he progressive angulatory deformity altecting the axis of movement of the related joint, lite re will he a little overall shortening.
After penetrating injuries, regeneration had first to take place from the surrounding cells. The growth plate determines the future length and shape of the mature bone. Injury to the perichondrial ring type 6 injury rang 28. Imaging of pediatric growth plate disturbances rsna publications. The epiphyseal plate may also he crushed in severe abduction and adduction injuries of the ankle. The growth plate, or physis, is the translucent, cartilaginous disc separating the epiphysis from the metaphysis and is responsible for longitudinal growth of long bones. With the exception of the distal femur, the ends of the long bones in the newborn are completely cartilaginous. Vertical fracture through all three components, metaphysis, physis and epiphysis. The growth plate, or physis, is the translucent, cartilaginous disc separating the epiphysis from the metaphysis and is responsible for longitudinal growth of long. They can also occur gradually as a result of repetitive stress on the bone, which may occur when a. If xrays appear normal but a growth plate fracture is suspected, patients are assumed to have a fracture, a splint or cast is applied, and. Fractures tend to propagate along the weakest zone. Conveniently the salterharris types can be remembered by the mnemonic saltr. Salter and harris, published more than a halfcentury ago, has had a lasting impact on the field of orthopaedic surgery and on the practice of medicine in general.
Remodeling of salterharris type ii epiphyseal plate injury. The growth plate, also known as the epiphyseal plate or physis. Salter harris ii fracture of the distal left tibia with mild displacement fracture of the epiphyseal plate and fracture of the metaphysis the fracture line extends into the metaphysis small piece of metaphysis can be seen as wedge shaped or a corner sign at the edge of metaphysis. They can also occur gradually as a result of repetitive stress on the bone, which may occur when a child overtrains in a sports activity. It is the part of a long bone where new bone growth takes place.
Disks of cartilage near each end of an immature long bone allow the bone to grow. It seems reasonable to investigate whether such injury influences the course after epiphyseal trauma. Complete remodeling was seen in children aged up to 10 years in all but one patient. Growth plate injuries orthopaedic trauma association ota. Growth plates are areas of growing tissues that cause the long bones in children and teens to grow.
Growth plate injuries happen to children and teens. Significant disturbance occurs in only 10% of epiphyseal injuries because of relationship of usual line of fracture to germinal cells of growth plate and epiphyseal blood supply. Jul 21, 2016 undoubtedly, more sophisticated imaging of injured extremities such as with mri will identify physeal injuries in the presence of normal plain radiographs 27. Undoubtedly, more sophisticated imaging of injured extremities such as with mri will identify physeal injuries in the presence of normal plain radiographs 27. In the trauma of physis, the proliferative layers are. Salterharris type i fractures are relatively uncommon injuries that occur in children. Physeal and epiphyseal cartilage injuries request pdf. We explain the types, treatments, and recovery times for this injury. The growth plate, also known as epiphyseal physeal plate or physis, is weaker than the nearby tendons, ligaments or joint capsule, and obviously weaker than bone.
Also known as the epiphyseal plate or physis, growth plates are the developing tissues at the end of long bones. Details on surgical treatment of growth plate fractures are beyond the scope of this article. Such longitudinal bone growth occurs here through the mechanism of endochondral ossification, with formation of cartilage and then remodeling into bone tissue fig. Stress fracture of the proximal humeral epiphysis in an. The classification of physeal injuries arc journals.
Pediatric sports medicine orthopedic institute for children, ucla dept of orthopedic surgery. Intuitively, it is the extent that overphysical activity may have on the growth plate resulting in injury. An acute stress fracture to the proximal humeral epiphysis was found. The epiphyses and epiphyseal plates are vital structures in the bone development of the growing athlete. Request pdf physeal and epiphyseal cartilage injuries the growth plate is responsible for the longitudinal growth of the long bones.
The risk of growth disturbance and its sequel is usually predictable and may. Both acute and chronic physeal injuries related to participation in sports have been reported to occur, although injury incidence data are somewhat limited. The authors describe a case of distal femoral physeal injury with disruption of the perichondrium in a 9yearold girl after a sledding accident. Not all fractures that extend to the growth plate are salterharris fractures. To deliver appropriate care to patients who have sustained acute or chronic growth plate injuries, clinicians should be able to identify the most common sites of injury, know the signs and symptoms associated with particular injuries, conduct a systemspecific physical examination, obtain necessary radiologic data, and provide appropriate management.
Salterharris fractures are injuries where a fracture of the metaphysis or epiphysis extends through the physis. Study ofsuch experimental injuries provides the basis ofdetermining both clinical treatment and prognosis. Pdf injuries involving the epiphyseal plate semantic. Epiphyseal definition of epiphyseal by the free dictionary. The salterharris classification describes growth plate injuries based upon location and likelihood of growth arrest. Most growth place injuries occur after a sudden accident, such as falling or having a hard hit to the limb. It is of particular benefit in the evaluation of injury to cartilaginous structures such as chondrocostal injury and physeal epiphyseal injury of the shoulders, elbows, hips, and knees in abused infants. Until your child reaches skeletal maturity, each long bone in her body has at least two growth epiphyseal plates one at each end.
An analysis of the reported cases of isolated epiphyseal injury of the distal ulna revealed that the cause of injury was a traffic accident or a fall in most cases. An elite junior badminton player presented with a chronic painful dominant shoulder after an intense training course. This guide aims to assist parents and coaches in identifying and avoiding the primary causes. The growth plate, or physis, is the name given to the area of cartilaginous tissue found between the epiphysis and metaphysis of skeletally imma ture bone. A salterharris fracture is an injury to the growth plate area of a childs bone.
Hence, ligamentous injuries, as well as traumatic dislocation of major joints are less common in childhood. If the latter occurs, joint function can be dramatically and permanently effected. They most commonly occur following trauma, although at the hip, a slipped upper femoral epiphysis sufe is a type i fracture that can occur without an acute traumatic event. A salterharris fracture or growth plate fracture is a fracture that involves the epiphyseal plate or growth plate of a bone. Long bones are bones that are longer than they are wide, such as in the legs, arms, toes, and fingers. Injury to either the growth plate direct injury or the adjacent epiphysis and metaphysis indirect injury can lead to growth plate dysfunction and future growth. Growth plate stress fractures tr british mountaineering council. Pdf apophyseal and epiphyseal knee injuries in the. Aug 07, 2007 the growth plate, also known as the epiphyseal plate or physis, is the area of growing tissue near the end of the long bones in children and adolescents. The first detailed description of injuries involving the epiphyseal plate was in 1863 by.
Treatment of epiphyseal injury of the distal ulna without. Experimental epiphyseal injuries willbediscussed under twoheadings. Faculty position sports medicinepediatricsfoot and ankle. A better appreciation of how epiphyseal plate physiology works is seen in the response to trauma. The patient presented with knee pain, limited range of motion. Diagnosis, management, and prevention francesca cimino, md, u. However, wed like to keep it that way, and the process to do this is prevent any injuries that will impact the kids in the future. Thus, knowledge of the prognosis for a given injury to the epiphyseal plate in a particular child is of considerable importance to the surgeon, who has the dual. This textbook is an overview of fractures of the physis, and is divided into three parts.
Growth plate injuries orthopaedic trauma association. The growth plate, also known as the epiphyseal plate is a thin layer of cartilage that lies between the epiphyses and metaphyses, and is where the growth of long bones takes place. Proximal humerus fracture or proximal humerus growth plate fracture occurs in children and teenagers as. Physeal injuries are very common in children, making up 1530% of all bony injuries.
Of particular concern is the growing number of stress. Growth plate injuries and management sciencedirect. Twoplane radiography will identify abnormalities of the growth. These fractures represent between 15% and 18% of all pediatric fractures, 24, 26 and present diagnostic and treatment challenges for orthopaedic surgeons. An unfused growth plate is less robust than ligamentous complexes and therefore is more easily injured. It is a common injury found in children, occurring in 15% of childhood long bone fractures.
An unfused growth plate is less robust than ligamentous complexes and. The growth plate may be injured with greater frequency than injuries to ligaments and bones due to the fact that the growth plate at this stage is the weakest link. Acute and chronic growth plate injuries american academy of. Injuries involving the epiphyseal plate present special problems in diagnosis and management. Injuries involving the epiphyseal plate request pdf. The lower radial epiphyseal plate isbyfartheonemost frequently separated byinjury. Epiphyseal injuries account for an estimated 15% of childhood fractures. Premature closure of the epiphyseal plates was seen involving the distal ulna in twenty.
The effects of physical activity on the epiphyseal growth. The epiphysis, involved in 6 to 15% of childrens fractures, is responsible for bone growth. The key difference between the childs bone and that of an adult is the presence of a physis. Salterharris iv accounts for 10% of all physeal injuries. Remodeling after salterharris type ii epiphyseal plate injury occurs in all age groups, but the potential is greater in children up to 10 years. Injury to the physis at the time of injury or due to treatment will continue to present problems until skeletal maturity respect the physis limit manipulation of the physis to 710 days post injury when reducing 90% of force in traction, 10% in translation. Oct 23, 2017 a salterharris fracture is an injury to the growth plate area of a childs bone.
Ultrasonography is an important adjunct study in the evaluation of trauma and suspected nat. Vessel damage leads to uneven growth patterns of response to ischemia of the epiphyseal a, b versus metaphyseal c, d circulatory systems. At each end of the bone, there is a growth plate or an epiphyseal plate, which is the last part of the bone to develop. Epiphyseal plate injuries getting children involved in climbing is fantastic, especially as climbing can be viewed as a lifelong sport. The epiphyseal plate is two to five times weaker than the surrounding fibrous tissue in children and adolescents. Salterharris classification radiology reference article. Mar 30, 2015 injuries involving the epiphyseal plate by drs. A potential problem with physical activity and exercise on the epiphyseal plates is overactivity. These areas of growing tissue, known as epiphyseal plates, harden as. Some information has been gathered about the relative frequency of physeal injuries. The salterharris classification was proposed by salter and harris in 1963 1 and at the time of writing june 2016 remains the most widely used system for describing physeal fractures. Epiphyseal plate injuries symptoms, causes, diagnosis, and treatment information for epiphyseal plate injuries growth plate injuries with alternative diagnoses, fulltext book chapters, misdiagnosis, research treatments, prevention, and prognosis. The secondary ossification centres appear during growth in a predictable pattern figure 14 and knowledge of the timing and pattern of appearance is important in assessing fractures around and into the joints.
The search was restricted to english language articles. Growth plate injuries are as their name describes injuries at the growth plate or growth center where tissue develops near the end of long bones in children and adolescents. Rutgers new jersey medical school faculty position the department of orthopaedics at rutgers new jersey medical school is actively recruiting for the followin. Physeal fractures are most common in 10to15yearold children ref. Jan 11, 2014 physis growth plate rapid longitudinal and diametric growth appreciated by growth of the secondary centre epiphyseal blood vessels penetrate to reach physisfig 2. A type i fracture accounts for approximately 6% of all growth plate fractures, and is characterized by a pure epiphyseal plate separation and includes no fractured bone. Epiphyseal plate growth plate physis metaphysis bone adjacent to the physis on the opposite side of the epiphysis. Growth plate injuries childrens hospital of philadelphia. Growth plate injuries and management orthopaedics and trauma. It also indicates three main types of a physeal plate injury, which include the separation of the epiphysis through the physeal plate, fractures that cross the physeal plate, and crushing injuries of the plate itself. Doctors test for growth plate injuries by asking about the injury, examining your child, and ordering xrays. Background injuries involving the epiphyseal plate are common and present special problems in diagnosis and management.
The level of injury varies in severity from minor epiphyseal separations requiring shortterm immobilization followed by rehabilitation to crushing of the plate leading to premature closing. This isnot true, however, oftwo types ofepiphyseal injury fractures that cross orcrush theepiphyseal plate. In this sense it may be considered an articular epiphysis. A guide for parents, coaches, gps and hand surgeons teenage children who climb and train intensively are more at risk of epiphyseal growth plate stress fractures of the finger.
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