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Epiphyseal
- 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
- 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)
- 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.