APPROACH TO COMMON FRACTURES OF THE IMMATURE SKELETON / GROWTH PLATE

Question 1

Buckle Fracture: Mechanism

Answer 1

FOOSH
Compressive Load -> incomplete stable fracture where one side buckles. Most commonly Metaphyseal.

Question 2

Buckle Fracture: Management

Answer 2

Distal Radial buckle fracture immobilized with plaster back slab
OR removable wrist splint for 3 weeks
Follow up with Ortho

Answer 3

Buckle Fracture

Question 4

Greenstick Fracture: Mechanism

Answer 4

Bowing Deformity of Cortex -> Incomplete fracture with one cortex in tact most commonly at diaphysis-metaphysis junction

Question 5

Greenstick Fracture: Management

Answer 5

May need to complete the fracture to reduce

Immobilize with plaster / fiberglass splint

Answer 6

Greenstick Fracture

Question 7

Avulsion Fracture: Mechanism

Answer 7

Forceful contraction of strong muscular attachment

Question 8

Avulsion Fracture: Management

Answer 8

Conservative with rest and altered weight bearing

Question 9

Bowing Fracture: Mechanism

Answer 9

Microfractures leading to plastic deformation with pain and deformity. Classic fracture line not present

Question 10

Bowing Fracture: Management

Answer 10

Immobilize
Requires reduction if >20 degrees deformity

Question 11

Bowing Fracture: Complications

Answer 11

May not remodel

Answer 12

Bowing Fracture

Question 13

Salter Harris I: Mechanism, XRAY findings, Management, Complications

Answer 13

Mechanism: fracture throught the growth plate; separation of the metaphysis and epiphysis

XRAY Findings: Unable to identify unless displaced

Reduce if displaced. Treat with splint (plaster or removable) for 4 weeks

Complications: Rarely associated with growth disturbance

Question 14

Salter Harris II: Mechanism, Management, Complications

Answer 14

Mechanism: Transverse fracture through the growth plate and oblique or vertical fracture through metaphysis

Treatment: Reduced if displaced. Splint with plaster or removable splint for 4 weeks

Complications: good prognosis

Question 15

Salter Harris III: Mechanism, Management, Complications

Answer 15

Mechanisms: Transverse fracture through the growth plate and a vertical fracture through the epiphysis; intra-articular

Management: Most require open reduction and internal fixation

Complications: risk of disruption and post-traumatic arthritis

Question 16

Salter Harris IV: Mechanism, Management, Complications

Answer 16

Mechanism: Vertical fracture through the metaphysis, physis and the epiphysis; intra-articular

Management: open reduction, internal fixation

Complications: High Risk of growth disruption

Question 17

Salter Harris V: Mechanism, XRAY Findings, Management, Complications

Answer 17

Mechanism: Crush injury to the growth plate

XRAY Findings: Rare and may be difficult to identify on XRAY

Management: Emergent Orthopedic consult

Complications: High incidence of growth arrest

Question 18

List and describe the 3 relevant areas of the bone

Answer 18

Diaphysis: Shaft of the long bong. Comprised of cortical bone and bone marrow

Metaphysis: wider part of the long bone closest to the epiphyseal plate.

Epiphysis: Rounded end of a long bone at it’s joint with the adjascent bone. Secondary ossification center separated from the rest of the bone by the epiphyseal or growth plate or physis.

Question 19

List 5 DDx for fractures of the immature skeleton / growth plate

Answer 19

Buckle Fracture
Greenstick Fracture
Avulsion Fracture
Bowing Fracture
Salter Harris Fracture I-V