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Injuries Involving the Epiphyseal Plate
Abstract
Injuries involving the epiphyseal plate present special problems in diagnosis and management. The dread complication of serious disturbance of growth is usually predictable and, in certain circumstances, can be prevented. Thus, knowledge of the prognosis for a given injury to the epiphyseal plate in a particular child is of considerable importance to the surgeon, who has the dual responsibility of treating the child and advising the parents. The purpose of this presentation is …
... The divergent epidemiology of ankle physeal fractures in historical and more recent studies probably correlates with paediatric populations' changing activities and lifestyles over the decades. Moreover, the wide range in the prevalence of PPC seen in distal tibial fractures -varying from 1% to 66.7% in the literaturecould be related to differences in sample sizes across epidemiological studies and the variable distributions of fracture patterns as classified using the Salter-Harris and Dias-Tachdjian systems [4,[10][11][12][13][14][15]. Thus, it is relevant to obtain robust epidemiological data on ankle physeal fractures to improve knowledge about their distribution by fracture pattern and age, as well as their actual incidence and the impact of PPC. ...
... We collected demographic data (age, sex, side of the injured ankle), injury information (date, season, mechanism of injury) and fracture patterns using the Dias-Tachdjian classification [15]. Fracture descriptions were based on conventional imaging studies using the Salter-Harris classification, and we noted whether the fractures were open or closed [14]. Patients were categorised based on pubertal status, with thresholds set at 11 years for girls and 13 years for boys. ...
... Most traumas occurred in the autumn, followed by spring and winter. This was slightly different from what is generally found in the literature, where it is suggested that the most consistent climatic factor related to paediatric trauma is hours of sunshine, with a higher average number of fractures in the summer -estimated to be 2.5 times higher than in winter [14,25]. The lower frequency of summer fractures may be explained by children leaving Geneva for holidays, with many thus experiencing fractures outside our referral area and thus not being admitted to our hospital. ...
INTRODUCTION: Ankle physeal fractures are a significant concern in paediatric populations due to their potential to cause growth disturbances, including premature physeal closure. The present study aimed to describe the epidemiology and injury patterns of ankle physeal fractures in children treated at a single university hospital centre in Switzerland over a 19-year period. MATERIALS AND METHODS: This retrospective cohort study included children aged 0 to 16 years who were admitted to our institution for an ankle physeal fracture between January 2004 and April 2023. Demographic and radiological data were collected, and fractures were classified according to the Salter-Harris and Dias-Tachdjian classifications. Statistical analyses, including Fisher’s exact test, were performed for dichotomous outcomes, with significance set at p<0.05. RESULTS: We included 259 patients with a mean age of 12.3 years old, mostly males (58.7%), with most fractures occurring among boys aged 14 and girls aged 12. Sports-related activities accounted for 51% of fractures, with the highest incidence in autumn. Isolated fractures of the distal tibia were most common (47.1%), and Salter-Harris type II fractures represented 51% of cases (p <0.05). The predominant mechanism of injury was supination–plantar flexion (33.6%). CONCLUSION: This study provided a comprehensive overview of the distribution and patterns of paediatric ankle physeal fractures. It underscored the need for future prospective multicentre studies to explore causative factors and outcomes related to growth disturbances. Targeted prevention and management strategies may help mitigate the incidence and consequences of these injuries.
... For the pediatric knee, the proximal tibial and distal femoral physes play a critical role in bone growth and development and are ultimately the most at risk during ACL surgical intervention. Significantly impacting leg length, the distal femoral physis contributes to approximately 10 mm of growth per year [16][17][18][19]. Thus, at the time of skeletal maturity, the distal femoral physis will have contributed 70% and 40% to the femoral length and overall length of the limb [16][17][18][19]. ...
... Significantly impacting leg length, the distal femoral physis contributes to approximately 10 mm of growth per year [16][17][18][19]. Thus, at the time of skeletal maturity, the distal femoral physis will have contributed 70% and 40% to the femoral length and overall length of the limb [16][17][18][19]. Closure of the distal femoral physis occurs on average between the ages of 16 and 18 for boys and ages 14 and 16 in girls [20,21]. ...
... Since the femoral physis is spared with this surgical technique, it reduces the likelihood of growth plate disturbances to the femur, which contributes to the greatest percentage of the limb's overall length [16][17][18][19]. On the tibial side, the transphyseal tunnel is drilled with the tunnel size and angle adjusted in a manner that minimizes the risk of growth disturbances. ...
The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk of secondary injuries, such as meniscal tears and chondral damage, due to prolonged joint instability. Conversely, early surgical intervention restores knee stability but raises concerns about potential growth disturbances, including leg-length discrepancies and angular deformities. This narrative review examines current approaches to pediatric ACL management, highlighting the risks and benefits of both conservative and surgical treatments. Additionally, it explores the role of finite element modeling (FEM) as an innovative tool for pre-surgical planning. FEM offers a non-invasive method to optimize surgical techniques, minimize iatrogenic damage to growth plates, and improve patient outcomes. Despite its potential, FEM remains underutilized in clinical practice. This review underscores the need to integrate FEM into pediatric ACL care to enhance surgical precision, reduce complications, and improve long-term quality of life for young patients. By synthesizing available evidence, this review aims to provide clinicians with a comprehensive framework for decision-making and identify future directions for research in pediatric ACL reconstruction.
... However, unlike medial condyle fractures of the humerus, medial epicondyle fractures only involve the extra-articular fracture of the medial epicondyle, while medial condyle fractures of the humerus are intra-articular fractures that may involve the trochlea of the humerus, the medial epicondyle, and part of the metaphyseal region of the humerus, presenting as a mirror-image symmetric injury to lateral condyle fractures. From a Salter-Harris classification perspective, these fractures are categorized as Salter-Harris type IV intra-articular epiphyseal fractures (7). Achieving anatomical reduction is essential, as inadequate reduction or improper management may lead to complications such as nonunion, malunion, osteonecrosis of the epiphysis, or elbow joint deformities (8), which can have irreversible consequences on elbow joint function and psychological well-being. ...
... On the other hand, pediatric medial condyle fractures of the humerus involve the joint surface, trochlear ossification center, epiphyseal plate, and distal humeral metaphysis, which are classified as Salter-Harris type IV intra-articular epiphyseal fractures (7). Once diagnosed with the medial condyle fractures of the humerus with displacement, surgical treatment is recommended to achieve anatomical reduction and stable fixation. ...
Objective
This study aims to investigate the clinical efficacy of elbow medial approach open reduction and internal fixation with absorbable cannulated screws for the treatment of Kilfoyle II and III type medial condyle fractures of the humerus in children.
Methods
A retrospective analysis was conducted on 23 pediatric patients with medial condyle fractures of the humerus who underwent surgical treatment at the Department of Pediatric Orthopedics, Foshan Traditional Chinese Medicine Hospital, from June 2018 to December 2023. Among the patients, 15 were male and 8 were female, with ages ranging from 5 to 12 years (mean age: 9.0 ± 2.4 years). According to the Kilfoyle classification, there were 3 cases of type II fractures and 20 cases of type III fractures. Of these, 19 were fresh fractures and 4 were neglected fractures. The surgical treatment involved open reduction and internal fixation through an elbow medial approach using absorbable cannulated screws. Postoperatively, the elbow joint was fixed in a functional position using a plaster cast. Four weeks postoperatively, follow-up radiographic examination showed continuous callus formation across the fracture line. The plaster cast was then removed, and active flexion and extension exercises of the elbow joint were initiated. The final follow-up assessment was performed using the Broberg-Morrey elbow joint functional scoring system to evaluate treatment efficacy.
Results
All patients were followed up for 3–12 months. All fractures achieved bony union without any breakage of the fixation devices. Among them, 2 cases had good functional scores for the elbow joint, while the others had excellent scores. None of the patients experienced complications such as infection, vascular or nerve injury, nonunion or malunion of fractures, heterotopic ossification, avascular necrosis of the medial epicondyle, or varus/valgus deformity of the elbow joint.
Conclusion
Open reduction and internal fixation through an elbow medial approach using absorbable cannulated screws demonstrates favorable clinical efficacy in treating Kilfoyle II and III type medial condyle fractures of the humerus in children. It can avoid the harm of secondary surgery to children, alleviate their pain, improve elbow joint function, and is considered the preferred method for treating pediatric medial condyle fractures of the humerus, deserving promotion and application in clinical practice.
... Physeal injuries, fractures involving the cartilaginous growth plates of skeletally immature individuals, represent a critical intersection of pediatric orthopedics and trauma care. Accounting for 15-30% of all childhood fractures, these injuries disproportionately affect active adolescents, with peak incidence between ages 10-14 years [1] . ...
... This classification is crucial as it has important implications for the prognosis and treatment of these injuries. Additionally, the Salter-Harris system facilitates effective communication among healthcare providers when discussing these pediatric fractures [1][2][3][4]. ...
... The type of injury, its severity, and the treatment all have a direct effect on the function and shape of the ankle joint [4]. Salter-Harris classification is the most commonly used anatomic system used to categorize fractures that occur in the growth plate of pediatric patients [5]. It is simple, and each injury type has prognostic significance. ...
Objective
To investigate the clinical efficacy and safety of 3D printing template in the fixation of distal tibial epiphyseal fractures in children.
Methods
A retrospective analysis was conducted on 57 cases of distal tibial epiphyseal fracture admitted to our hospital between January 2017 and January 2023. 27 patients underwent the conventional operative technique (conventional group), while the remaining 30 patients underwent the 3D printing template (3D printing template group). Exclusions comprised patients presenting with pathological fracture, neuromuscular disorder, metabolic disease, prior tibial fracture or instrumentation, and polytrauma. Additionally, individuals with a follow-up duration of less than 12 months or incomplete medical records were excluded. The reduction effect was evaluated using radiographs, and the times of fluoroscopy, operation time, time to union, and complications (such as infection or loss of reduction) were documented. Ankle joint function was assessed by the AOFAS score.
Results
A total of 57 patients were divided into two groups: the conventional group, comprising 27 patients (14 males, 13 females), and the 3D printing template group, consisting of 30 patients (19 males, 11 females). Patients in both groups were followed up for at least one year, with an average of 2.3 years (1–3 years). The two groups exhibited no statistically significant differences in terms of sex, age, body weight, mechanism of injury, time from injury to surgery, Salter-Harris classification, or concomitant injuries. There was no significant difference in length of hospital stay, time to union, and limb length discrepancy between the two groups (P > 0.05). However, there was significantly less operative time in the 3D template group compared with the conventional group (P < 0.05). Higher intraoperative fluoroscopy frequency was observed in the conventional group than in the 3D template group (P < 0.001). However, the hospitalization expenses were higher in the 3D template group (3784 ± 315.7 ). No infection, nonunion, delayed union, malunion, loss of reduction, or premature epiphyseal closure between the two groups. Tendon adhesions were observed in 10 cases in the conventional group, contrasting with 12 cases in the 3D template group. In the final follow-up, AOFAS scores reflected excellence in 26 cases and goodness in one in the conventional group, while excellence was noted in 28 cases and goodness in two in the 3D template group, culminating in an outstanding rate of 100% for both excellence and goodness.
Conclusion
The conventional technique and 3D printing template technique both met the treatment requirements of distal tibial epiphyseal fractures. 3D printing guide plate provides a new method for distal tibial epiphyseal fractures with high accuracy and safety compared with traditional method by reducing the times of fluoroscopy and operating time.
Clinical trial number
Not applicable.
... The type of injury, its severity, and the treatment all have a direct effect on the function and shape of the ankle joint [4]. Salter-Harris classi cation is the most commonly used anatomic system used to categorize fractures that occur in the growth plate of pediatric patients [5]. It is simple, and each injury type has prognostic signi cance. ...
Objective To investigate the clinical efficacy and safety of 3D printing template in the fixation of distal tibial epiphyseal fractures in children. Methods A retrospective analysis was conducted on 57 cases of distal tibial epiphysis fracture admitted to our hospital between January 2017 and January 2023. 27 patients underwent the conventional operative technique (conventional group), while the remaining 30 patients underwent the 3D printing template (3D printing template group). Exclusions comprised patients presenting with pathological fracture, neuromuscular disorder, metabolic disease, prior tibial fracture or instrumentation, and polytrauma. Additionally, individuals with a follow-up duration of less than 12 months or incomplete medical records were excluded. The reduction effect was evaluated using radiographs, and the times of fluoroscopy, operation time, time to union, and complications (such as infection or loss of reduction) were documented. Ankle joint function was assessed by the AOFAS score. Results A total of 57 patients were divided into two groups: the conventional group, comprising 27 patients (14 males, 13 females), and the 3D printing template group, consisting of 30 patients (19 males, 11 females). Patients in both groups were followed up for at least one year, with an average of 2.3 years (1–3 years). The two groups exhibited no statistically significant differences in terms of sex, age, body weight, mechanism of injury, time from injury to surgery, Salter-Harris classification, or concomitant injuries. There was no significant difference in length of hospital stay, time to union, and limb length discrepancy between the two groups (P > 0.05). However, there was significantly less operative time in the 3D template group compared with the conventional group (P < 0.05). Higher intraoperative fluoroscopy frequency was observed in the conventional group than in the 3D template group (P < 0.001). However, the hospitalization expenses were higher in the 3D template group (3784 ± 315.7 ). No infection, nonunion, delayed union, malunion, loss of reduction, or premature epiphyseal closure between the two groups. Tendon adhesions were observed in 10 cases in the conventional group, contrasting with 12 cases in the 3D template group. In the final follow-up, AOFAS scores reflected excellence in 26 cases and goodness in one in the conventional group, while excellence was noted in 28 cases and goodness in two in the 3D template group, culminating in an outstanding rate of 100% for both excellence and goodness. Conclusion The conventional technique and 3D printing template technique both met the treatment requirements of distal tibial epiphysis fractures. 3D printing guide plate provides a new method for distal tibial epiphysis fractures with high accuracy and safety compared with traditional method by reducing the times of fluoroscopy and operating time. Clinical trial number Not applicable
... Triplane fractures represent 5% to 10% of pediatric intra-articular ankle injuries and typically occur in children aged 10 to 17 years [4]. While distal tibia epiphysis fractures can be classified according to the Salter-Harris classification [5], triplane ankle fractures are difficult to classify according to this system for a variety of reasons. To begin with, triplane fractures occur in the sagittal, axial, and coronal planes, with some variations including two-, three-, and four-part fractures, involvement of the medial or lateral regions, and configurations that can be either intra-articular or extra-articular ( Figure 1) [6]. ...
Background/Objectives: Triplane ankle fractures represent a complex fracture type in pediatric patients. These fractures can prove challenging due to the involvement of multiple fracture planes and variations in segment fragmentation. With increasing literature pertaining to the treatment of triplane fractures and the limitations of previous systematic reviews, the aim of this review is to summarize recent data on the diagnosis, treatment, and complications of pediatric triplane ankle fractures. Methods: This systematic review was conducted following PRISMA guidelines and searched five major databases up to July 2024. The inclusion criteria focused on observational studies and randomized controlled trials in pediatric triplane fractures. Case reports, cadaveric studies, and systematic reviews were excluded. Articles were screened and graded using the MINORS tool for quality assessment. Data were extracted on demographics, fracture types, treatment approaches, and outcomes. Results: A total of 34 studies met the inclusion criteria. The use of CT scans in combination with radiographs was common, and two-part fractures were the most frequently observed type. Surgical treatment, particularly open reduction with internal fixation, was preferred, while conservative surgical treatment remains under-reported. Complications were minimal, with limb length discrepancy being the most common. Conclusions: This review highlights the increased use of CT for diagnosing triplane fractures and the preference of certain surgical interventions. Conservative treatment approaches, though less studied, may offer alternatives in moderate cases. This review emphasizes the need for further research on conservative treatment outcomes, longer follow-ups, and randomized controlled trials to refine treatment strategies for this complex fracture pattern.
... Defined as radiopaque lines visible on radiographs; the lesion must expand over at least 50 % of the medullary cavity and be transverse (Harris, 1931;Hummert and Van Gerven, 1985;Kulus and Dąbrowski, 2019;Macchiarelli et al., 1994;Scott and Hoppa, 2015). The etiology is related to malnutrition, food poisoning, alcohol abuse, breastfeeding and weaning patterns, Salter-Harris fractures, socioeconomic status, characteristics at delivery and gestation, metabolic disorders (e.g., anemia, diabetes, rickets, marasmus, kwashiorkor, scurvy, vitamin A and K deficiency), infections (e.g., tuberculosis, chickenpox, pneumonia, measles, influenza), endocrine conditions (e.g., hypothyroidism, Cushing's syndrome), and congenital disorders (e.g., thalassemia, juvenile idiopathic arthritis) (Ameen et al., 2005;Beom et al., 2014;Bessler, 1982;Blanco et al., 1974;Edwards, 1993;Georgiadis and Gannon, 2022;Gindhart, 1969;González-Reimers et al., 2007;Grolleau-Raoux et al., 1997;Macía-Villa et al., 2016;Miller and Rubell, 1934;Papageorgopoulou et al., 2011;Park, 1964;Piercecchi-Marti et al., 2006, 2006Piga, 2017;Rosen and Deshmukh, 1985;Salter and Harris, 1963;Wongdee et al., 2012Wongdee et al., , 2012Zimmermann and Boelaert, 2015). All long bones of the upper and lower limbs were selected to observe Harris lines. ...
To examine differences in lifestyle between urban and rural settings during the Imperial period in Italy, a comparative study was undertaken between the rural necropolis of Contrada Nevola (1st-3rd century CE) in Corinaldo (Ancona) and the urban necropolis of Università Cattolica in Milan (1st-5th century CE). Anthropo-logical and radiographic investigations were conducted on 60 individuals from Corinaldo and 50 from Milan, focusing on stress markers (cribriotic lesions, Harris lines, enamel hypoplasia, Schmorl's nodes, entheseal changes, and antemortem trauma). Individuals from Corinaldo appear to have experienced better living conditions compared to their counterparts in Milan. Furthermore, based on stress markers distribution, disparities in resource access and possibly different work-related tasks between sexes were more pronounced in rural settings than in urban ones. The synergistic approach combining anthropological and radiological methods for analyzing lifestyle provided comprehensive insights into the individuals buried in these necropolises. Through this comparative analysis, we aim to contribute to the understanding of the social and environmental dynamics that shaped the lives of past populations, thus offering new perspectives for comprehending the evolution of human societies and their interactions with the environment.
... 1,3 The Salter-Harris classification, introduced by Salter and Harris in 1963, is presently the most commonly used classification system in the pediatric population within the literature. 12, 13 Salter-Harris type I and II injuries are the most common types of fractures in the proximal humerus. 13 The Salter-Harris II injury is frequently seen in adolescents who have had blunt shoulder trauma. ...
... In addition to the AO classification, which can be used for adult fractures, it includes the degree of dislocation (3). The most common classification was established by Salter and Harris, which describes the fracture course in comparison with the epiphyseal plate (17). To be mentioned, the less-known Ogden classification differentiates the injuries not only by localization but also by causes. ...
Introduction
Injuries to the epiphyseal plate are of great concern as they can affect bone growth. Although epiphyseal fractures are common in adolescents, fractures of the distal femoral epiphyseal plate are rare.
Case presentation
We present a case of a Salter–Harris type 1 fracture of the distal epiphysis of the femur that was self-inflicted by a patient with paraplegia due to spina bifida. The patient was brought to the pediatrician's attention during a routine checkup with an apparent swelling of the right thigh. Upon presentation, we performed a radiograph and an additional MRI, which revealed a partial ventero-medial epiphyseolysis, consistent with a Salter–Harris type 1 fracture. Due to the dislocation, we indicated closed reduction with K-wires. Repositioning was performed using a modified Kapandji maneuver and was completed with additional K-wires.
Conclusion
Distal epiphyseolysis is a relatively rare injury that can lead to serious complications. Therefore, although rare, epiphyseal fractures should be considered in pediatric patients presenting with uncertain limb swelling.
... Greenstick fractures are commonly found in growing individuals and are typically incomplete, bending fractures caused by continuous stress on the bone (Rodríguez-Merchán, 2005). The ossification zone is known to be a weak spot in growing mammals and often involved in fractures (Salter & Harris, 1963;Johnson et al., 1994). Indeed, we were able to demonstrate how one fracture occurred right by the junction between the ossification zone and bone tissue in a 28 WOA hen. ...
The keel bone in laying hens is prone to fractures, especially on the caudal third of the keel, which is also the last part to ossify. Keel bone fractures (KBF) typically occur between 25 and 50 weeks of age (WOA). However, the keel is fully ossified at around 40 WOA, suggesting fractures can occur before ossification is complete. To better understand the relationship between KBF and ossification, this descriptive study examined keel bone morphology during maturation. Keel bones from 50 commercial aviary housed Dekalb White laying hens were collected at 10 timepoints from 17-53 WOA and prepared for histological analysis. The samples were stained with haematoxylin and eosin and Safranin O to show cartilage, ossification, bone tissue, and KBF. The results indicated an ossification process similar to endochondral ossification. The degree of ossification varied between individuals of the same age. The age at complete ossification varied from 28-49 WOA. None of the keels from hens aged 53 WOA were fully ossified. Cartilage canals were present in the keel cartilage. Medullary bone was observed in all age groups. Most fractures lacked tissue morphologies typical of high-impact collisions, suggesting the need for further research into the underlying causes. This is the first study to detail keel bone histomorphology in commercial laying hens, providing baseline data for future research.
... The triplane ankle fracture accounts for approximately 5% of all ankle fractures in children, being more common in the older ones with an average age of occurrence of 13 years [1]. It is named after its geometry and involves a metaphyseal (Salter-Harris type 2) and epiphysial components (Salter-Harris type 3) [2]. The epiphysial component is classically described as an articular fracture of the distal tibial epiphysis in its weight-bearing portion. ...
This article aims to describe a multicenter cohort of atypical triplane ankle fractures with intramalleolar involvement of the epiphysis, providing insights into the affected population, treatment outcomes, and complications. In addition, we propose a treatment strategy for such fractures based on our findings. A retrospective analysis was conducted on adolescent patients diagnosed with triplane ankle fractures. Data from three participating centers in Brazil and Argentina were collected and analyzed. Treatment strategies, including surgical and nonsurgical approaches, were evaluated. Clinical outcomes such as pain levels, functional scores (AOFAS), and return to normal activities were assessed. Radiographic evaluations were performed to evaluate fracture healing and alignment. Data were collected from seven patients with an average age of 13 years. The sample consisted predominantly of male patients (6/7), with the left side affected (6/7) and Shin type 3 fractures. Two cases were treated conservatively, with consolidation within the expected period without subsequent displacements or negative functional repercussions (AOFAS score, 100). In surgical cases, starting fixation from the metaphysis made it possible to avoid fixation of the epiphyseal fragment in all cases, except one. All surgically treated cases had consolidation within the expected time, without subsequent deviations or complications. This multicenter evaluation offers valuable insights into the presentation of fractures, diverse treatment approaches employed, and their respective clinical and radiographic outcomes. However, further prospective studies with larger sample sizes are necessary to validate these findings and to establish evidence-based treatment guidelines for this specific fracture pattern in the adolescent population.
... The proximal radial physis represents a weak area in children. As the surrounding ligaments are stronger, forces tend to fracture the proximal radial physis (Salter Harris injury) instead of radial head dislocation in children [4,5]. Monteggia variants consisting of a proximal ulna fracture with radial neck fracture have been described in the literature. ...
Introduction: The common mechanism of injury for Monteggia fracture is fall on outstretched hand with elbow extended and forearm in pronation causing a proximal fracture of ulna with dislocation of radial head. Monteggia injuries were classified by Bado into 4 sub-types based on the direction of displacement of the radial head and the presence of associated fracture (type 1 with anterior dislocation of radial head being most common). We managed two cases of Monteggia type 1 variant injury consisting of a fracture of the radial neck and anterior displacement of distal radial shaft without dislocation of the radiocapitellar joint. Case report: We operated two children (5 and 9 years old respectively) with this Monteggia variant injury; displaced ulna shaft fracture with volar angulation, and fracture neck radius with anterior displacement of radial shaft. Ulna fracture was fixed by elastic nailing and radial neck fracture was managed by closed means (with or without fixation). At final follow up (2 and 7 years later respectively), both the children had excellent outcomes with good range of pronation and supination movements. Conclusion: In the management of Monteggia equivalent lesions, an understanding of the direction of displacement of radial shaft will help in formulating the appropriate method of fracture reduction. Closed reduction of the radial neck fracture is preferred since the results of open reduction are poor especially in terms of regaining pronation and supination movements. Keywords: Monteggia, Forearm fracture, Monteggia variant
... e Salter-Harris classification [2] [ Figure 1 and Table 1] has described five types of physeal injuries. Studies have shown that displaced fractures have a significantly higher growth disturbance rate than undisplaced fractures. ...
Physeal fractures in newborns are relative rare injuries, most often occurring as a result of birth trauma. Salter-Harris fractures of the distal femur should be treated as knee dislocation and, hence, as a medical emergency. A high index of suspicion for vascular injury should be present. Reduction, stabilization, and, if necessary, vascular repair should be carried out at the earliest to avoid permanent damage/deformity. We report a case of distal femoral physeal fracture and dislocation in a 2-day old neonate presenting with a swollen knee and decreased motion of the right lower extremity shortly after delivery.
Aims
The remarkable capacity for distal radius fractures in children to remodel raises questions about the necessity and extent of the intervention required to achieve anatomical alignment. The British Society of Children’s Orthopaedic Surgery prioritized this uncertainty as one of their most important research questions. This is the protocol for a randomized, controlled, multicentre, prospective, noninferiority trial of non-surgical casting versus surgical reduction for severely displaced fractures of the distal radius in children: the Children’s Radius Acute Fracture Fixation Trial.
Methods
Children aged four to ten years old inclusive, who have sustained a severely displaced distal radius fracture, are eligible to take part. Baseline function using the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Score, pain measured using the Wong-Baker FACES Pain Scale, and quality of life (QoL) assessed with the EuroQol five-dimension questionnaire for younger participants will be collected. Each patient will be randomly allocated (1:1), stratified using a minimization algorithm by centre, fracture type at presentation (completely off-ended or incompletely off-ended), fracture location (metaphyseal or physeal), and age group (four to six years or seven to ten years) to either a regimen of non-surgical casting or surgical reduction.
Conclusion
At six weeks, and three, six, and 12 months, data on function, pain, QoL, cosmesis, and satisfaction with care will be collected. After completion of the main phase of the study, patients will be followed up for a further two years. Up to one year after randomization, the main outcomes plus data on complications, resource use, and school absence will be collected. The primary outcome is the PROMIS Upper Extremity Score at three months post-randomization. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardians.
Cite this article: Bone Jt Open 2025;6(5):560–568.
Diaphyseal overgrowth is a well‐documented complication of long bone fracture in orthopedic studies, but it is not a condition commonly mentioned in the forensic literature as a possible indicator of child abuse. Here we present an occurrence of humeral hypertrophy associated with a physeal fracture to the left distal humerus in a case of infant child abuse. Humeral overgrowth was present in this infant along with superficial bruising, other humeral fractures, rib fractures, and vertebral injuries consistent with battered child syndrome. In 2002, the humeri, lower ribs, and vertebrae of this infant were examined for evidence of injury by Phillip Walker using gross observations, radiographs, and CT scans. After completion of his case report and before the remains were returned to the Medical Examiner, one of the authors used 3D surface scan imaging to generate digital models of the humeri in order to calculate the volume of each bone for purposes of size comparison. The difference in volume was notable and consistent with other measurements demonstrating hypertrophy of the left humerus. This case report combines the results of these earlier analyses with information drawn from original case files and more recent clinical studies to demonstrate that humeral asymmetry caused by hypertrophy from a fracture can provide relevant evidence of previous injury in cases of child abuse, even when the fracture is no longer visible in radiographs. This study also highlights the utility of combining 3D surface scan imaging with other radiographic methods when conducting medicolegal casework.
A 9‐month‐old male entire flat‐coated retriever was referred for investigation of chronic right pelvic limb lameness following trauma. Radiographs and contrast‐enhanced CT confirmed a right femoral head Salter–Harris type III fracture with monostotic metaphyseal mixed‐type lysis and joint effusion. An aggressive process due to underlying neoplasia or infection with secondary pathological fracture could not be excluded. The dog underwent surgical bone biopsy and, consequently, right femoral head and neck ostectomy (FHO). Histopathology described retained cartilage cores within the trabecular bone of the metaphysis and periosteal resorption in the right femoral head and neck, with no signs of inflammation or malignancy.
Over the past two decades, advances in pediatric orthopedics and closed reduction combined with percutaneous internal fixation techniques have led to significant growth in pediatric orthopedics surgery. Implants such as Kirschner-wires, cannulated screws and elastic stabilization intramedullary nails are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers and biodegradable metals. This article provides a comprehensive summary of these resorbable materials from a clinician's perspective. In addition, an in-depth discussion of the feasibility of their clinical applications and related research in pediatric orthopedics is included. We found that the applications of absorbable implants in pediatric orthopedics are shifting from absorbable polymers to biodegradable metals and emphasize that the functional characteristics of resorbable materials must be coordinated and complementary to the treatment in pediatric orthopedics.
In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC).
We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts.
PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5 mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5 cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2 cm, and five patients with PPC complained of postoperative pain.
Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5 mm are at a higher risk for PPC.
Observational study. Level of evidence III.
Objective To determine (1) whether the tibial plateau angle (TPA) in dogs with Salter–Harris type 1 (SH-1) or type 2 (SH-2) fractures of the proximal tibial physis significantly decreases in the time between diagnosis and reevaluation following surgical repair and (2) whether the method of surgical repair influences the change in TPA over time.
Study Design This study was a retrospective study. Medical records from 2017 to 2022 were reviewed to identify dogs with SH-1 or SH-2 fractures of the proximal tibial physis that had undergone surgical repair with Kirschner wires (K-wires), with or without a tibial tuberosity tension band. The TPA of the affected limb was measured by four investigators on radiographs taken prior to surgery, immediately postoperatively and at 4–8 weeks follow-up, with the average values recorded.
Results A total of 32 dogs, 22 fractures repaired with K-wires and a tension band, and 10 with K-wires only. There was a mean decrease in TPA from injury to first reevaluation of 5.89 degrees (p < 0.001) and from immediately postoperatively to first reevaluation of 2.2 degrees (p = 0.018); however, no significant decrease in TPA was observed when comparing fractures repaired with or without a tension band.
Conclusion The TPA of dogs with SH-1 and SH-2 fractures of the proximal tibial physis decreased in the reevaluation interim following repair with K-wires with or without a tension band. Despite initial imperfect reduction, the risk of cranial cruciate ligament rupture may not be increased, potentially reducing the need for additional surgery if high TPA is observed postoperatively. This study was overrepresented by small breeds, and future studies on large and giant breeds with extended follow-up would be indicated.
Projection radiography is the basis of imaging. In the wrist, it is important to obtain dorsopalmar and lateral views in a neutral position to assess carpal stability. Other projections include the Stecher view to assess the scaphoid and the ball grip stress view to detect scapholunate instability. Computed tomography (CT) should be used extensively to assess osseous pathology, particularly in fractures of the distal radius and carpal bones. This requires thin slices (< 1 mm), overlapping image reconstructions, and a small scan field that allows secondary image reconstructions in orthogonal and oblique planes. - Magnetic resonance imaging (MRI) is the method of choice for imaging bone marrow, hyaline articular cartilage and soft tissues. Important indications for MRI include synovial disease, bone and soft tissue tumors, carpal osteonecrosis and clarification of unclear symptoms. - Direct CT and MR arthrography are used to detect lesions of the scapholunate ligament, lunotriquetral ligament, TFCC and articular cartilage with high accuracy. [Chapter in German].
Primary periphyseal stress injuries (PPSIs) to the hand and fingers are rare, and most are reported as digital physeal stress injuries to the fingers among adolescent rock climbers. There are over 200 cases, and lately therapeutic and diagnostic guidelines have been published. Early diagnosis is important for a good outcome, and most of these injuries can be treated conservatively. Only those cases that show no tendency to fuse or contain superimposed dislocated fracture require surgery. Other stress-related injuries to the hand and fingers include Kienböck’s, Dietrich’s, and Thiemann’s disease. These tend to occur infrequently, and only small case series have been published in the literature. Therapy is mostly conservative, only certain stages of the conditions require a surgical procedure.
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