|
Year |
2002 |
|---|---|
|
Question Number |
57 |
|
Category |
Pediatric Orthopaedics |
Question
A 7-year-old boy who fell on his outstretched hand sustained the closed fracture shown in figures 10a and 10b. Management consists of application of a long arm cast. There is no change in position of the bone following cast application. Based on these findings, the parents should be advised that the most likely outcome will be
1- healing with resumption of normal growth
2- partial premature growth arrest
3- complete growth arrest
4- delayed union
5- osteonecrosis of the distal radial epiphysis
Figures
Answer (click for answer)
Preferred response: 1.
The fracture shown is a Salter-Harris II. Type I is a transphyseal fracture, type II is a transphyseal fracture that exits through the metaphysis, type III is a transphyseal fracture that exits through the epiphysis, type IV is a fracture that traverses the epiphysis and physis exiting the metaphysis and type V is a crush injury to the physis. The first reference states that a Salter-Harris II involving the distal radius is the most common fracture in children, and these fractures usually heal rapidly resulting in normal growth. The second reference states that premature growth arrest in these fractures is dependent on the specific physis injured, the force of injury, the degree of displacement and comminution, age of the patient and the type of fracture.
Reference: Peterson HA: Physeal fractures: Part 2. Two previously unclassified types. J Pediatr Orthop 1994;14:431-438.