Abstract
Background
The presence of growth plates at the ends of long bones makes fracture management in children unique in terms of the potential risk of developing angular deformities and growth arrest.
Materials and Methods
We discuss three distinct cases depicting various aspects of physeal injury of the lower extremity in children.
Results
The case illustrations chosen represent distinct body regions and different physeal injuries: Salter-Harris II fracture of the distal femur, Salter-Harris VI perichondrial injury of the medial aspect of the knee region, and Salter-Harris III fracture of the distal tibia. The clinical presentation, pertinent history and physical findings, imaging studies, management, and subsequent course are presented.
Conclusions
Growth plate injuries of the lower extremity require a high index of suspicion and close monitoring during skeletal growth. Early recognition and proper management of these injuries can minimize long term morbidity. The treatment plan should be individualized after a comprehensive analysis of the injury pattern in each patient. Establishing a long term treatment plan and discussing the prognosis of these injuries with the child’s caretakers is imperative.
Similar content being viewed by others
References
Flynn JM, Skaggs DL, Waters PM. Rockwood & Wilkins’ Fractures in Children. 8th ed. Philadelphia: Wolters Kluwer Health; 2015. p. 1288.
Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am 1963;45:587–622.
Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: A meta-analysis. J Orthop Trauma 2009;23:663–7.
Arkader A, Warner WC Jr., Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop 2007;27:703–8.
Ilharreborde B, Raquillet C, Morel E, Fitoussi F, Bensahel H, Penneçot GF, et al. Long term prognosis of Salter-Harris type 2 injuries of the distal femoral physis. J Pediatr Orthop B 2006;15:433–8.
Close BJ, Strouse PJ. MR of physeal fractures of the adolescent knee. Pediatr Radiol 2000;30:756–62.
Kearney SP, Mosca VS. Selective hemiepiphysiodesis for patellar instability with associated genu valgum. J Orthop 2015;12:17–22.
Swarup I, Elattar O, Rozbruch SR. Patellar instability treated with distal femoral osteotomy. Knee 2017;24:608–14.
Rang M, Pring ME, Wenger DR. Rang’s Children’s Fractures. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 311.
Havranek P, Pesl T. Salter (Rang) type 6 physeal injury. Eur J Pediatr Surg 2010;20:174–7.
Foster BK, John B, Hasler C. Free fat interpositional graft in acute physeal injuries: The anticipatory Langenskiöld procedure. J Pediatr Orthop 2000;20:282–5.
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994;25:425–65.
Podeszwa DA, Mubarak SJ. Physeal fractures of the distal tibia and fibula (Salter-Harris type I, II, III, and IV fractures). J Pediatr Orthop 2012;32 Suppl 1:S62–8.
Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 1992;280:48–64.
Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res 1992;280:65–71.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sabharwal, S., Sabharwal, S. Growth Plate Injuries of the Lower Extremity: Case Examples and Lessons Learned. IJOO 52, 462–469 (2018). https://doi.org/10.4103/ortho.IJOrtho_313_17
Published:
Issue Date:
DOI: https://doi.org/10.4103/ortho.IJOrtho_313_17