1. Physeal injuries Kakwani

2. Introduction Introduction The physis The physis Classification of physeal injuries Classification of physeal injuries Principles of management Principles of management

3. Introduction Skeletal trauma: 10-15 % Skeletal trauma: 10-15 % Physeal disruptions : 30 % Physeal disruptions : 30 % Male : Female = 2 : 1 Male : Female = 2 : 1 54% : Salter-Harris II 54% : Salter-Harris II < 2 yr old consider NAI < 2 yr old consider NAI

4. Robert Salter B.1924, Canada B.1924, Canada Pioneered development of children's orthopaedic surgery. Pioneered development of children's orthopaedic surgery. Surgeon-in-Chief, Hospital for Sick Children Surgeon-in-Chief, Hospital for Sick Children

5. W. Robert Harris 1922–2005 Professor: Division of Orthopaedic Surgery, University of Toronto President of the Canadian Orthopaedic Foundation

6. Mercer Rang 1933 -2003, b. London 1933 -2003, b. London Graduated UCH Graduated UCH Wrote many books on children's fractures Wrote many books on children's fractures Staff of Hospital for Sick Children Staff of Hospital for Sick Children

9. Epiphyseal blood supply

10. Physeal trauma Rotation/ Shear Rotation/ Shear Low velocity Low velocity Occult Occult Rapid healing - < 3 weeks Rapid healing - < 3 weeks Relevance decreases with age. Relevance decreases with age.

11. Classifications Poland1898 Salter - Harris 1963 Aitken1965 Rang1969 Weber1980 Ogden1981 Peterson1994

12. Type 1

13. Type 2

14. Type 3

15. Type 4

16. Type V

17. Deformities following Type 5

18. Type VI Added by Rang (1969) Added by Rang (1969) Apophyseal injuries Apophyseal injuries

19. Principles of management Diagnosis Diagnosis Goals Goals Reduction Reduction Avoid growth plate arrest Avoid growth plate arrest Return of function Return of function Operative or non-operative Operative or non-operative

20. Principles of management Diagnosis: Diagnosis: Index of suspicion Index of suspicion Contralateral x-rays Contralateral x-rays CT CT

21. Principles of management Goals Goals Reduction Reduction Avoid growth plate injury Avoid growth plate injury Return of function Return of function

22. Principles of management Non-operative treatment: Non-operative treatment: Types I & II Types I & II Timing Timing Manipulation vv traction Manipulation vv traction Acceptable deformity Acceptable deformity Remodeling potential Remodeling potential

23. Principles of management Operative treatment: Operative treatment: Types III & IV Types III & IV Periosteal interposition (type II) Periosteal interposition (type II) Timing Timing Crossing the growth plate Crossing the growth plate Remodeling potential Remodeling potential

25. Questions ???

26. References

27. References RB Salter, WR Harris. Injuries involving the eiphyseal plate. JBJS Vol 45. 1963. p 587-632. RB Salter, WR Harris. Injuries involving the eiphyseal plate. JBJS Vol 45. 1963. p 587-632. Physeal Arrest. Ogden-John-A. The Journal of Bone and Joint Surgery (American Volume). 1987 Oct. 69-A(8). pp 1297-1302. Physeal Arrest. Ogden-John-A. The Journal of Bone and Joint Surgery (American Volume). 1987 Oct. 69-A(8). pp 1297-1302. Injuries of the epiphyseal plate. RBSalter. Instructional Course Lectures. Vol 41. 1992. p 351-359. Injuries of the epiphyseal plate. RBSalter. Instructional Course Lectures. Vol 41. 1992. p 351-359. Peterson.J. Physeal Fractures. Part 3. Classification.J Pediatric Orthopedics. Vol 14(4). 1994. p 439-448 Peterson.J. Physeal Fractures. Part 3. Classification.J Pediatric Orthopedics. Vol 14(4). 1994. p 439-448 Green: Skeletal Trauma in Children 3 rd ed. Elseiver. 2003. Green: Skeletal Trauma in Children 3 rd ed. Elseiver. 2003. Robert B. Salter: Disorders and Injuries of the Musculoskeletal System, 3rd Edition., Baltimore, Williams and Wilkins, 1999 Robert B. Salter: Disorders and Injuries of the Musculoskeletal System, 3rd Edition., Baltimore, Williams and Wilkins, 1999

28. Thank You