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Classification and treatment of physeal fractures

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The physis or growth plate allows longitudinal growth of long bones. The Salter and Harris classification (1963) is the most practical and used today. Fractures of the physis are classified according to the line of the fracture.


Salter and Harris Classification de Salter y Harris (Fig 8)


Figura 8. Salter and Harris classification of fractures of the physis or growth plate.


The physeal fractures type I or II (extra-articular), generally require reduction if they are bent more than 15-20 ° (Fig. 9A).

The intra-articular forms require surgery if they are displaced. The interruption of the physis may cause its closure, thus altering bone growth. The joint surface irregularities lead to risk of OA of the joint over time. Usually, Kirshner wires or screws are used.


Figure 9A. Salter and Harris type II fracture of the distal radius. It was not reduced in the operating room due to medical problems, and remained in a cast. It will eventually remodel with time

Physeal closure, physeal bridge

The growth plate injury by a fracture or other causes (infection, tumors, etc.) can lead to bone bridge that would prevent the normal growth of the physis. The end result would be a shorter and / or angled extremity (Fig. 9B)

Figure 9B
. Metaphyseal infection of distal radius, with injury to the physis. Over time, the radius does not grow well and is shorter than the ulna.

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