Diagnosis and Management of Physeal Injuries


Knowledge of the macroscopic and microscopic anatomy of the growth plate is essential for successful management of physeal injuries. Damage to any area of the physis can lead to significant abnormalities of physeal growth and long bone development. In general, there are a number of standard rules or guidelines that should be followed in the management of physeal fractures. Nondisplaced or minimally displaced type I and type II injuries usually can be managed effectively with closed manipulative reduction and appropriate casting or splinting. Surgical treatment with either percutaneous or open fixation is indicated for fractures that extend to the joint surface (type III and type IV fractures) because intra-articular discontinuity can lead to early degenerative arthritis, and physeal discontinuity can result in disruption of longitudinal bone growth.

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