Epiphyseal

1. Extern conference
Ext.Jan
5422069

2. Case
▷เด็กชายไทย อายุ 10 ปี
▷Chief complaint
: ปวดข้อมือขวา 1 วัน

3. Primary survey
▷Airway
patent airway , no tenderness along C spine , can active
neck movement all direction
▷Breathing
Normal breathsound clear both lungs, CCT negative
▷Circulation
BP 100 / 56 mmHg, PR 68 bpm
▷Disability
E4V5M6 ,pupil 2 mm react to light both eyes
▷Exposure
No external wound , tenderness and limit ROM Rt wrist

4. Secondary survey
▷Allergy
no drug, no food allergy
▷Medication
No current medication
▷Past illness
No underlying disease
▷Last meal
12.00น.

5. Secondary survey
▷Event
1 day PTA โดนลูกฟุตบอลเตะใส่ข้อมือด้านขวา หลังจากนั้นมีอาการปวด
บวมแดงที่ข้อมือขวา ขยับข้อมือไม่ได้ เมื่อขยับแล้วมีอาการปวด กระดก หรืองอข้อมือลาบาก

6. Physical examination
• Vital sign BP 100 / 56 mmHg, PR 68 bpm
RR 20/min Temp 36.5 ˚C
• HEENT not pale conjunctiva anicteric
sclera
• Heart normal S1S2 no murmur
• Lungs normal breathsound clear both
lungs
• Abdomen soft not distend not tender
normoactive bowel sound

7. Physical examination
▷Extremities
Mild swelling and tenderness
Pain on active movement
Limit ROM on Flexion and extension Rt. Wrist
No external wound , no deformity
Radial pulse 2+ capillary refill < 2 sec

8. Physical examination

9. Film Rt. wrist AP Lateral

10. Diagnosis
▷Epiphyseal plate injury Rt. Wrist Type I

11. Management
▷Control pain
▷Close reduction
▷On Short arm AP slap and arm sling

12. Film Rt. wrist AP Lateral (on slap)

13. Epiphyseal plate injury

14. Anatomy
▷Growth plates are
found in the long bones
▷Growth plates are located
between the metaphysis
and the epiphysis

15. ▷15-30% of fracture in childern
▷All children who are still growing
• risk for growth plate injuries
• peaks in adolescence.
▷occur twice as often in boys as in girls
• girls finish growing earlier than boys.
Epidermiology

16. Mechanism of injury
▷Direct injury
▷Indirect injury
• repetitive stress on the bone

17. Prognosis
▷ most 85% of growth plate injuries heal
without complication

18. Presentation
▷Visible deformity
▷An inability to move or put pressure on the limb
▷Swelling, warmth, and tenderness

19. Salter and Harris classification

20. Salter and Harris classification
▷Type I Injuries
• Due to a separation through the growth
• plate of the metaphysis and diaphysis.

21. Salter and Harris classification
▷Type II Injuries
• Fracture traverses physis and exits
metaphysis
• most common type

22. Salter and Harris classification
▷Type III Injuries
• fracture traverses physis and exits epiphysis

23. Salter and Harris classification
▷Type IV Injuries
• fracture passes through epiphysis,
physis, metaphysis

24. Salter and Harris classification
▷Type IV Injuries
• crush injury to physis

25. Management

26. Complication
▷Growth arrests
• Most common in Type IV and Type V
- complete arrest leads to shortening
- partial arrest leads to angulation

27. Long-Term Follow-up
▷3- to 6-month intervals for at least 2 years.
• make sure that the growth plate is growing
appropriately.