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Emergency Med/Trauma > Physeal Injuries > Flashcards

Physeal Injuries Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Areas proximal and distal to the physis?

A

Proximal - Diaphysis and Metaphysis

Distal - Epiphysis

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2
Q

Horizontal and spherical growth plates are responsible for?

A

Horizontal - endochondral ossification and length

Spherical - epiphyseal growth in appositional direction

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3
Q

The cells closest to the epiphysis are?

A

Cartilaginous

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4
Q

Zone of growth

A

Resting, dividing and columnation

Contributes to appositional growth through the zone of ranvier

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5
Q

Zone of maturation

A

Hypertrophy and calcification

MOST COMMON area of fracture

Decreased vascularity

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6
Q

Zone of transformation

A

Vascular penetration and ossification

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7
Q

Zone of Ranvier

A

Surrounds the growth zone

Composed of fibrovacular tissue, mesenchyme, epiphyseal and physeal cartilage, and osseous ring of Lacroix

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8
Q

Ring of Lacroix

A

Extension of the metaphyseal cortex that acts as a peripheral restraint to the cell columns and provides stability to the physis

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9
Q

Remodeling Zone

A

Osteoblasts lay down primary spongiosa that is replaced by secondary spongiosa with NO cartilage remnants

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10
Q

Explain physeal growth ceasing with regard to capillary loops

A

Metaphyseal and nutrient arteries form closed capillary loops within the cartilage transformation zone and when the loops touch, physeal GROWTH CEASES

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11
Q

To allow ingrowth of metaphyseal vessels, what must cartilage do?

A

Cartilage MUST sufficiently calcify

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12
Q

Difference between epiphysis and apophysis?

A

Both are secondary ossification centers, however…

Epiphysis –> forms joints
Apophysis –> attachment for tendon

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13
Q

Describe SH I

A

Through the hypertrophic zone

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14
Q

SH 1 tx

A

Closed reduction
NWB cast 3 wks
WB cast another 3 wks

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15
Q

SH II

A

Partially splits the physis and through the metaphysis

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16
Q

What is a Thurston-Holland sign?

A

Metaphyseal triangular shaped piece of bone that results from SH II fracture

17
Q

MOST common physeal fracture?

A

SH II

18
Q

SHII

A

Partially extends through physis and exits through epiphysis into the joint.

19
Q

SH III tx

A

ORIF

20
Q

SH IV

A

Runs obliquely through the metaphysis, through the physis, and then through epiphysis and enters the joint.

21
Q

SH IV tx

A

ORIF

22
Q

SH V

A

Compression or crush of the physis that is difficult to diagnose b/c no fracture line evident

23
Q

SH VI

A

Damage to the periosteum or perichondral ring with resultant bony bridge formation external to growth plate

24
Q

SH VII

A

Damage to epiphysis and not to physis

25
Q

SH VIII

A

Damage to the metaphysis and not to physis

26
Q

SH IX

A

Injury to diaphyseal periosteum that may result in disruption of normal diaphyseal growth and remodeling

27
Q

What to use when doing ORIF for physeal fractures

A

Only smooth pins
Parallel pins are safer
Remove pins EARLY

28
Q

Transitional fractures

A

Result of external rotation force applied to the foot
Occur when the tibial physis is closing.
Includes tillaux and triplane fractures

29
Q

What is the sequence of tibial physis closure?

A

Central > medial > posterior > anterolateral

30
Q

What is a Tillaux fracture?

A

Anterolateral portion is fractured. Considered a SH III.

Fracture displaced anteriorly and laterally.

31
Q

Triplane fracture

A

Involves external rotation, eversion, and plantarflexion forces.
One part always involves metaphysis of the tibia.
Displaced lateral or medial

32
Q

Explain the follow-up process for these fractures

A

X-ray every 6-12 months to asses growth disturbance

33
Q

Explain a Harris/Park line

A

Transverse sclerotic line that is proximal to the epiphysis. It is a growth arrest line that develops during periods of absent growth following trauma.

34
Q

Difference b/w parallel and oblique Harris lines

A

Parallel harris lines result in minimal physeal damage

Non-parallel lines tend to converge with the physis and indicates damage

Emergency Med/Trauma (26 decks)

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