![]() These patients should be discussed with the orthopaedic service. More angulation can be accepted in children less than eight years old and those presenting late.įor patients who have a delayed presentation of physeal fracture >5 days, it is not advisable to attempt closed reduction, as this increases the risk of growth plate injury. Angulation is less acceptable if there is less than two years of growth remaining. In general, distal radial physeal fractures that are angulated >20 degrees (as seen on the lateral x-ray) need to be reduced. When is reduction (non-operative or operative) required? This AP and lateral x-ray shows a bony bar extending across the growth plate of the distal radius, indicating the presence of a growth arrest.ħ. Salter-Harris type IV fractures are very rare.įigure 4: A type V fracture will not be visible in an acute injury but is usually recognised later because of growth arrest and progressive deformity. Salter-Harris type III fractures are rare. On lateral view, the fracture pattern through the growth plate is more evident. The key clinical sign is localised tenderness.įigure 3: AP and lateral x-ray of 13 year old boy with Salter-Harris type II fracture. These fractures are difficult to see on x-ray and are primarily diagnosed on clinical findings. A Salter-Harris type I fracture occurs through the growth plate. Table 1: Salter-Harris fracture classification.įigure 2: AP and lateral x-ray of 10 year old girl with Salter-Harris type I fracture. Examine for tenderness in the anatomical snuff box and consider ordering scaphoid views. If, in an older child with a painful wrist (as a result of a fall on an outstretched hand), there is no distal radial fracture seen on x-ray, consider the possibility of a scaphoid fracture. If there are any elbow joint symptoms, an 'elbow x-ray' should be ordered as some fractures around the elbow can be difficult to detect. Avoid ordering 'x-ray arm' as it is better to have images focused to the region of local tenderness. If the injury is to the mid forearm or the pain is poorly localised, a 'forearm x-ray' should be ordered. What radiological investigations should be ordered?Īppropriate analgesia and splinting for pain relief prior to x-ray is required.Ī 'wrist x-ray' request will provide anteroposterior (AP) and lateral views of the distal forearm and wrist. Remember to always examine the elbow for associated injuriesĥ. Deformity depends on the degree of physeal displacement. There is usually pain and tenderness directly over the fracture site, and limited range of motion in the wrist and hand. Commonly there is an associated ulna fracture (greenstick, physeal or styloid).įigure 1: Dorsal (posterior) displacement of the distal fragment is usually the result of a fall on an extended wrist. Extension of the wrist at the time of injury causes the distal fragment to be displaced dorsally (posteriorly). The most common mechanism of injury is a fall on an outstretched hand (Figure 1). Distal radial physeal fractures are uncommon in children younger than five years. The Salter-Harris type II fracture is the most common type. The peak age for injury to the growth plate is in the pre-adolescent growth spurt. How common are they and how do they occur? Radial physeal fractures can occur in isolation or be associated with an ulna fracture (greenstick, physeal or styloid). Physeal fractures are classified by the Salter-Harris classification and whether the radius, ulna, or both bones are injured. Not seen in acute injury diagnosis usually made in retrospect Refer to orthopaedics - usually requires open reduction and internal fixation (ORIF)įracture clinic as per post-operative orders Refer to orthopaedics if unable to perform closed reductionįracture clinic within 5 days of immobilisation Reduction is not advisable after ≥5 days of initial injury Undisplaced: Below-elbow plaster backslab or removable splint for 4 weeksĭisplaced: Closed reduction and below-elbow plaster backslab for 4 weeks Rarely associated with growth disturbance Salter-Harris fracture type and frequency What are the potential complications associated with this injury?.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?.Distal radial physeal fractures - Fracture clinics
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