Growth Plate Fractures

Question 1

Basic Bone Anatomy

Answer 1

• Diaphysis - shaft of long bone
• Metaphysis - b/n shaft and epiphysis
• Epiphysis - secondary ossification center; separated from parent bone by cartilage;
• Physis - (“growth plate”) plate b/n epiphysis and metaphysis

Question 2

Salter Harris Classification

Answer 2

• I - straight thru physis itself (Straight)
  
  • Point tenderness along joint line
• II - thru physis and extends up into metaphysis (Above)
  
  • From shearing force
• III- from articular surface –> thru epiphysis –> exits physis (Lower)
  
  • Poorer prognosis b/c intra-articular involvement
• IV - THRU articular surface –> epiphysis, physis, metaphysis (Thru)
  
  • Can disrupt growth; often need surgical reduction to ensure good growth
• V- crush injury right at physis w/o fracture (Rammed)
  
  • Axial load
  • Premature growth plate closure - long-term abnormalities (limb discrepancy)
  • Can be hard to distinguish from type I

Question 3

Pathophysiology + Complications

Answer 3

• Fracture at physis - makes sense b/c weak (in middle of growing)
• Can lead to premature growth arrest
• Most common during growth spurts (weakest b/c most turnover)
• Female 11-12 yo
• Male 12-14 yo (males > females more high risk activities)