eMedicine Specialties > Orthopedic Surgery > Pediatrics

Growth Plate (Physeal) Fractures: Workup

Author: Charles T Mehlman, DO, MPH, Director, Musculoskeletal Outcomes Research, Associate Professor, Division of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center
Coauthor(s): Matthew E Koepplinger, DO, Assistant Professor, Department of Orthopaedic Surgery, Baylor College of Medicine; Staff Physician, Department of Orthopaedic Surgery, Ben Taub General Hospital, Houston
Contributor Information and Disclosures

Updated: Aug 12, 2008

Workup

Imaging Studies

  • Many acute physeal injuries are not clearly visible on plain radiographs due to the cartilaginous-osseous nature and irregular contours of the physes.
    • Plain radiographs may depict physeal widening as the only sign of displacement. In order to help delineate the injury, 2 views (anteroposterior and lateral) are necessary. Occasionally, comparison views of the opposite extremity may be helpful. Comparison views can help establish occult separation of the physis, as in an SH I injury.
    • Radiographic stress views (varus and valgus) may be indicated in certain patients. They are not recommended in all instances, as stress maneuvers may cause further physeal damage. However, stress radiographs may be necessary in order to accurately diagnose physeal plate injury. Stress views may prove particularly useful to demonstrate separation between the epiphysis and metaphysis in injuries around the knee and elbow.9
  • CT scans are at times necessary to delineate fragmentation and orientation of severely comminuted epiphyseal and metaphyseal fractures.10
  • Bone scans are not particularly helpful, as the physes are normally relatively active on nuclear scans.
  • Magnetic resonance imaging (MRI) has proven to be the most accurate evaluation tool for the fracture anatomy when performed in the acute phase of injury (initial 10 d). MRI can depict altered arrest lines and transphyseal bridging abnormalities prior to their being evident on plain radiographs.

More on Growth Plate (Physeal) Fractures

Overview: Growth Plate (Physeal) Fractures
Workup: Growth Plate (Physeal) Fractures
Treatment: Growth Plate (Physeal) Fractures
Follow-up: Growth Plate (Physeal) Fractures
Multimedia: Growth Plate (Physeal) Fractures
References
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References

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Further Reading

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Keywords

growth plate fracture, epiphyseal fracture, physeal injury, physeal fracture, epiphyseal plate injury, physis fracture, epiphyseal cartilage, growth plate injury, epiphyses, epiphyseal fracture, bone plate, sprain, strain, ankle fracture, ankle sprain, wrist fracture, wrist sprain, knee fracture, knee sprain, hip fracture, hip sprain

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Contributor Information and Disclosures

Author

Charles T Mehlman, DO, MPH, Director, Musculoskeletal Outcomes Research, Associate Professor, Division of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center
Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Coauthor(s)

Matthew E Koepplinger, DO, Assistant Professor, Department of Orthopaedic Surgery, Baylor College of Medicine; Staff Physician, Department of Orthopaedic Surgery, Ben Taub General Hospital, Houston
Matthew E Koepplinger, DO is a member of the following medical societies: American Osteopathic Academy of Orthopedics and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Mininder S Kocher, MD, MPH, Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston
Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the History of Medicine, American Medical Association, American Orthopaedic Society for Sports Medicine, and Massachusetts Medical Society
Disclosure: Smith & Nephew Endoscopy Consulting fee Consulting; ConMed Linvatec Consulting fee Consulting; Covidian Consulting fee Consulting; EBI Biomet Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

George H Thompson, MD, Director, Pediatric Orthopedics, Rainbow Babies and Children's Hospital
George H Thompson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

 
 
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