Physeal fractures

Question 1

How much weaker is the physis compared to the attachement of ligaments a joint capsue to bone?

Answer 1

3-5x weaker

Question 2

What are the main types of growth plates?

Answer 2

Pressure - found at the ends of long bones
Traction - found where muscles insert or originate, and these contribute little to bone growth

Question 3

Types of Salter Harris fractures?

Answer 3

and type VI - bony bridge across growth plate - angular deformity

Question 4

What is important to tell the owners of animals with physeal injury?

Answer 4

ALWAYS WARN the possibility of early physeal closure -> risk of angular defomrity

Question 5

What are the principles of repair of physeal fractures?

Answer 5

1) early surgery (within 24-48h)
2) if articular surface involved -> treat like articular fracture (articulation more important than physis)
3) careful handling - fragments/physis can crumble
4) most of germinal cells remain on epiphyseal fragment - handle with care
5) External coaptation - for some type I and II, all type V + VI are conservatively handled at first
6) use implants taht minimally disrupt physis (e.g. K-wires)
7) implants should affect less than 10% of the surface of the growth plate
8) implants that compress or span the physis should be avoided
9) removal of implants once the fracture has healed nay allow for continued growth