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EPIPHYSEAL PLATE

FRACTURES

By
Dr.JURSAL HARUN,SpOT
SPECIAL PROBLEMS
 DIAGNOSIS

 TREATMENT

 DISTURBANCE OF LOCAL GROWTH

 PROGRESSIVE BONY DEFORMITY


DIAGNOSIS
 A fracture near the end of a long bone
 A dislocation or ligamenious injury (including
a sprain)
 Radiographic examination
- At least two projections at right angles
- Comparable projections of the same region
of the opposite uninjured limb
SALTER HARRIS
CLASSIFICATION
Based on :

- Mechanism of injury

- Method of treatment
TYPE I

Complete
separation of the
epiphysis without
any fracture
through bone
Mechanism : Shearing force

Common : New born and young children


Epiphyseal plate is relatively thick

Treatment : Closed reduction

Prognosis : Excellent
TYPE II
-Commonest type
-The line of fracture
separation extends along
the epiphyseal plate to a
variable distance and
then out through a
portion of the
metaphysis producing a
triangular shaped
metaphyseal fragment
Mechanism : Shearing and bending
forces

Common : Older children in whom the


epiphyseal plate is relatively
thin
Treatment : Closed reduction

Prognosis : Excellent
TYPE III

Fracture is intra
articular extends
from the joint surface
to the deep zone of
the epiphyseal plate
and then along the
plate to its periphery
Mechanism : Intra articular shearing force
and is usually limited to the distal tibial
epiphysis

Treatment : Open reduction to restore a


perfectly normal joint surface

Prognosis : Good
TYPE IV
Fracture is intra articular
extends from the joint
surface to the epiphysis,
across the entire
thicness of the
epiphyseal plate and
through a portion of the
metaphysis

Lateral condyle of the


humerus
Treatment : Open reduction to restore a
perfectly normal joint surface and perfect
a position of the epiphyseal plate

Prognosis :
Bad unless perfect reduction is both
obtained and maintained
TYPE V

Relatively
uncommon injury
Mechanism :
- A severe crushing force being applied
through the epiphysis to one area of the
epiphyseal plate.
- Region knee and ankle

- Diagnosis is difficult because the

epiphysis is not usually displaced


TYPE VI
Injury to the peripheral perichondrial ring
(zone of ranuier)

Mechanism :
- A Direct blow
- Open slicing mechanism by sharp object such
as the blade of a power lawn mover

Prognosis : Bad
PROGNOSIS CONCERING
GROWTH DISTURBANCE
 TYPE OF INJURY
 AGE OF THE CHILD
 BLOOD SUPLY TO THE EPIPHYSIS
 METHOD OF REDUCTION
 OPEN OR CLOSED INJURY