Injuries involving the epiphyseal plate

Abstract

Background Injuries involving the epiphyseal plate are common and present special problems in diagnosis and management. The risk of growth disturbance and its sequel is usually predictable and may be preventable. In this instructional course lecture, Dr Salter and Dr Harris presented in great depth a classifi cation system based on the mechanism of injury and the relationship of the fracture line to the growth plate. The classifi cation is also correlated with the prognosis concerning growth disturbance. This classifi cation system, which carries their name, subsequently became the most widely accepted system, and whilst some authors have suggested minor modifi cations, the basic system has proved to be quite reliable. Methods The study was based on animal experiments to produce physeal injuries seen in clinical practice: the three main types of injuries are separation of the epiphysis through its physeal plate, fractures that cross the physeal plate and crushing injuries of the plate itself. Clinical and histological assessments were conducted. Results Based on their experiments, they classifi ed physeal injures into fi ve types: Type I: There is a complete separation of the epiphysis from the metaphysis without any bone fracture. The growing cells of the epiphyseal plate remain with the epiphysis. This type of injury is common in early childhood when the epiphyseal plate is relatively thick or in some pathological process such as scurvy, rickets, and endocrine disorders. This fracture type is usually caused by a shearing or avulsion force. Prognosis is generally excellent unless the epiphysis is entirely covered with cartilage (as in the proximal femur) where blood supply is frequently damaged. Type II is the commonest type with the line of separation extending along the epiphyseal plate for a variable distance and then out through a portion of the metaphysis. This fracture type is usually caused by a shearing or avulsion force. The growing cartilage cells remain with the epiphysis thus the prognosis is excellent. Type III is uncommon; the fracture line extends from the joint surface to the epiphyseal plate and then extends along the plate to the periphery. It is usually caused by intra-articular shear force. Prognosis is usually good provided the blood supply to the separated part of the epiphysis remains intact.