eMedicine Specialties > Orthopedic Surgery > Pediatrics

Growth Plate (Physeal) Fractures: Multimedia

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

Multimedia

Growth plate (physeal) fractures. John Hunter (17...Media file 1: Growth plate (physeal) fractures. John Hunter (1728-1793), the "father of the growth plate."
Growth plate (physeal) fractures. John Hunter (17...

Growth plate (physeal) fractures. John Hunter (1728-1793), the "father of the growth plate."

Growth plate (physeal) fractures. Clinical appear...Media file 2: Growth plate (physeal) fractures. Clinical appearance of the knee of a patient with a minimally displaced Salter-Harris I fracture of the distal femur. Impressive swelling was noted adjacent to the joint, but no evidence of intra-articular swelling was present. The patient was markedly tender to palpation about the distal femoral physis.
Growth plate (physeal) fractures. Clinical appear...

Growth plate (physeal) fractures. Clinical appearance of the knee of a patient with a minimally displaced Salter-Harris I fracture of the distal femur. Impressive swelling was noted adjacent to the joint, but no evidence of intra-articular swelling was present. The patient was markedly tender to palpation about the distal femoral physis.

Growth plate (physeal) fractures. Anteroposterior...Media file 3: Growth plate (physeal) fractures. Anteroposterior radiograph of the knee of the patient from Image 2. Note subtle physeal widening confirming the diagnosis of a Salter-Harris I fracture of the distal femur.
Growth plate (physeal) fractures. Anteroposterior...

Growth plate (physeal) fractures. Anteroposterior radiograph of the knee of the patient from Image 2. Note subtle physeal widening confirming the diagnosis of a Salter-Harris I fracture of the distal femur.

Growth plate (physeal) fractures. Anteroposterior...Media file 4: Growth plate (physeal) fractures. Anteroposterior ankle radiograph demonstrating an impressively displaced Salter-Harris II fracture of the distal tibial epiphysis (along with comminuted fracture of distal fibular diaphysis).
Growth plate (physeal) fractures. Anteroposterior...

Growth plate (physeal) fractures. Anteroposterior ankle radiograph demonstrating an impressively displaced Salter-Harris II fracture of the distal tibial epiphysis (along with comminuted fracture of distal fibular diaphysis).

Growth plate (physeal) fractures. Displaced Salte...Media file 5: Growth plate (physeal) fractures. Displaced Salter-Harris II fracture of the distal femur. The large Thurstan Holland (metaphyseal) fragment may serve an important fixation point for either a Steinmann pin or a lag screw.
Growth plate (physeal) fractures. Displaced Salte...

Growth plate (physeal) fractures. Displaced Salter-Harris II fracture of the distal femur. The large Thurstan Holland (metaphyseal) fragment may serve an important fixation point for either a Steinmann pin or a lag screw.

Growth plate (physeal) fractures. Multiple comput...Media file 6: Growth plate (physeal) fractures. Multiple computed tomography (CT) scan images depicting a displaced Salter-Harris III fracture of the distal anterolateral tibial epiphysis (ie, Tillaux fracture).
Growth plate (physeal) fractures. Multiple comput...

Growth plate (physeal) fractures. Multiple computed tomography (CT) scan images depicting a displaced Salter-Harris III fracture of the distal anterolateral tibial epiphysis (ie, Tillaux fracture).

Growth plate (physeal) fractures. Displaced Salte...Media file 7: Growth plate (physeal) fractures. Displaced Salter-Harris IV fracture of the proximal tibia. The lateral portion of the epiphysis (with the Thurstan Holland fragment) and the medial portion of the epiphysis are independently displaced (ie, each are free-floating fragments).
Growth plate (physeal) fractures. Displaced Salte...

Growth plate (physeal) fractures. Displaced Salter-Harris IV fracture of the proximal tibia. The lateral portion of the epiphysis (with the Thurstan Holland fragment) and the medial portion of the epiphysis are independently displaced (ie, each are free-floating fragments).

Growth plate (physeal) fractures. The Salter-Harr...Media file 8: Growth plate (physeal) fractures. The Salter-Harris V fracture pattern must be strongly suspected whenever the mechanism of injury includes significant compressive forces. This is the initial injury radiograph of a child's ankle that was subjected to significant compressive and inversion forces. It demonstrates minimally displaced fractures of the tibia and fibula with apparent maintenance of distal tibial physeal architecture.
Growth plate (physeal) fractures. The Salter-Harr...

Growth plate (physeal) fractures. The Salter-Harris V fracture pattern must be strongly suspected whenever the mechanism of injury includes significant compressive forces. This is the initial injury radiograph of a child's ankle that was subjected to significant compressive and inversion forces. It demonstrates minimally displaced fractures of the tibia and fibula with apparent maintenance of distal tibial physeal architecture.

Growth plate (physeal) fractures. Follow-up radio...Media file 9: Growth plate (physeal) fractures. Follow-up radiograph of the ankle of the child in Image 8. This radiograph depicts growth arrest secondary to the Salter-Harris V nature of the injury. Note the markedly asymmetric Park-Harris growth recovery line, indicating that the lateral portion of the growth plate continues to function and the medial portion does not.
Growth plate (physeal) fractures. Follow-up radio...

Growth plate (physeal) fractures. Follow-up radiograph of the ankle of the child in Image 8. This radiograph depicts growth arrest secondary to the Salter-Harris V nature of the injury. Note the markedly asymmetric Park-Harris growth recovery line, indicating that the lateral portion of the growth plate continues to function and the medial portion does not.

Growth plate (physeal) fractures. Mortise radiogr...Media file 10: Growth plate (physeal) fractures. Mortise radiograph demonstrating somewhat subtle physeal injury to distal tibia. The Salter-Harris VI pattern may be suspected based upon history and physical examination findings. In this case, the radiograph indicates that it is quite likely that a small portion of the peripheral medial physis (as well as a small amount of adjacent epiphyseal and metaphyseal bone) has been avulsed.
Growth plate (physeal) fractures. Mortise radiogr...

Growth plate (physeal) fractures. Mortise radiograph demonstrating somewhat subtle physeal injury to distal tibia. The Salter-Harris VI pattern may be suspected based upon history and physical examination findings. In this case, the radiograph indicates that it is quite likely that a small portion of the peripheral medial physis (as well as a small amount of adjacent epiphyseal and metaphyseal bone) has been avulsed.

Growth plate (physeal) fractures. Clinical photog...Media file 11: Growth plate (physeal) fractures. Clinical photograph of the patient from Image 5. This mechanism of injury and physical examination findings are consistent with the Salter-Harris VI physeal injury pattern. Some may also refer to this injury type as a Kessel fracture.
Growth plate (physeal) fractures. Clinical photog...

Growth plate (physeal) fractures. Clinical photograph of the patient from Image 5. This mechanism of injury and physical examination findings are consistent with the Salter-Harris VI physeal injury pattern. Some may also refer to this injury type as a Kessel fracture.

Growth plate (physeal) fractures. Radiographic ev...Media file 12: Growth plate (physeal) fractures. Radiographic evidence of a pediatric stubbed great toe.
Growth plate (physeal) fractures. Radiographic ev...

Growth plate (physeal) fractures. Radiographic evidence of a pediatric stubbed great toe.

Growth plate (physeal) fractures. Clinical appear...Media file 13: Growth plate (physeal) fractures. Clinical appearance of a pediatric stubbed great toe. Note the subungual hematoma, representative of an open fracture.
Growth plate (physeal) fractures. Clinical appear...

Growth plate (physeal) fractures. Clinical appearance of a pediatric stubbed great toe. Note the subungual hematoma, representative of an open fracture.

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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Further Reading

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

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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