PHYSEAL

INJURY

HIL - ORTHOPAEDI

ANATOMY
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 Physis is a Greek word (phyein)

which means nature, or to generate

ANATOMI

English medical dictionaries :

the segment of bone responsible for
growth in length of the bone
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ANATOMI
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ANATOMI
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ANATOMI
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ANATOMI
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GROWTH

ANATOMI

Growth patterns of a typical enchondral bone. a In

addition to longitudinal growth, the flat primary physis
(PP) initially also grows latitudinally (circumferentially).
The developing secondary center of ossification
enlarges globally from its own spherical secondary
physis (SP). b Once the secondary center of ossification
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(SCO) is relatively mature, latitudinal growth of the
physis is essentially appositional growth, supplied by

ANATOMI

Temporary ischemia of the metaphysis impedes the

enchondral ossification process, but not growth of the
germinal and columnar layers of the physis
Temporary ischemia of the epiphyseal blood supply
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results in death of the germinal cells and loss of

ANATOMI

Relative growth from each end of the major long

bones. The horizontal line represents birth. The
numbers represent the final percentage of growth
supplied by each end of the bone
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CLASSIFICATION
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Foucher

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Aitken

ANATOMI

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Rang

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Comparison of comprehensive physeal

classifications

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EPIDEMIOLOGY
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Comparison of physeal fractures to total

fractures in children
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Comparison of physeal fractures: upper

versus lower extremity
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Relative frequency of physeal fractures

by site, 19701990

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Distribution of physeal fractures by type

(Salter-Harris Classification)

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EVALUATION
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EVALUATION
History
birthfractures,childabuse,andcongenitalinsensitivity
topain,afall,asportsactivity,oramotorvehicle
accident.Mechanismofinjury(i.e.,abduction,
adduction,varus,valgus,rotation,andsoforth)

Physical Examination
Localizedpain,swellingandtenderness,ecchymosisand
muffledcrepitance,jointswelling(hemarthrosis),
ambulationisrestrictedornotpossible,Displaced
fracturesmayexhibitlimbdeformity
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 Imaging
TimeofAppearance
ofOssificationCentersand
ClosureofPhyses

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Roentgenograp
hy

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MANAGEMENT
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Guide to the care of the growth-plate injury

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theepiphysisseparatescompletelyfrom
themetaphysis
Usuallytheresultofshearing,torsion,or
avulsionforce
Healingoccurswhitin3weeks
Goodprognosis

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Theplaneofcleavagepassesthrough
muchoftheplatebeforethefracture
travelsthroughthemetaphysis
Producebylateraldisplacementforces
Usuallyeasilyreduced
Ifthedegreeofdisplacementis
unacceptable,openreductionmaybe
needed
Goodprognosis
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Theplaneofseparationpassesalongwith
thegrowthplateforavariableperiod
beforeenteringthejointthroughafracture
oftheepiphysis
Thefractureisintraarticularandrequires
accuratereduction
Openreductionmaybeneeded

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The fracture line passes through from

the joint surface, across the epiphysis,
growth plate, and into metaphysis
The fracture must be accurate reduced,
usually by open reduction to secure
a smooth joint surface

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Uncommon
Commonlymissed
Highindexofsuspicionnecessary
Warnparentsofpossiblegrowth
disturbancesinthefuture

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Management Choices

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Internal Fixatio

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COMPLICATION
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The type, number, and percentage of

complications by site in Olmsted County,
Minnesota, 19791988

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Complications occurring at or near the tim

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Complications manifesting later

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REFERANCES

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TERIMA
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