Treatment of physeal injuries

Type I. Closed reduction and immobilization is usually satisfactory. Approximately 3% develop a growth arrest.

Type II. Closed reduction, but a K-wire is occasionally required. Reduction is sometimes blocked by interposed periosteum, particularly in the distal tibia. The wire is best placed through the Thurston-Holland fragment; however, it is permissible to pass a thin, non-threaded wire across the physis. Manipulation after 5-7 days is


Figure 1. The Salter and Harris classification of physeal fractures. Types I to IV can easily be remembered, although it should be noted that type II is viewed as a mirror image. Type IV is the 'Rang' fracture, with injury of the perichondral rim.

controversial - some consider this will further damage the physis, and prefer to perform a late osteotomy.

Type III. Requires anatomical reduction usually with ORIF. Some authors do not even accept 2 mm of displacement. Fixation is with transverse wires or screws, fixing epiphysis to epiphysis. Growth arrest is common, but frequently unimportant as the fracture occurs around the time of skeletal maturity.

Type IV. As with type 3, this is an intra-articular fracture and often needs ORIF.

Type V and VI. These are diagnosed late.

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