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Epiphyseal Injury

Salter Harri Types
Fracture line is entirely with in Physis - epiphyseal seperation (without metaphyseal & epiphyseal fragment)
Fracture line extends from physis into the Metaphysis 1/t metaphyseal fragment (Thurston-Holland’s fragment sign)
Fracture line extends from physis into the Epiphysis and almost always exits the articular surface
Fracture line extends across the Epiphysis, (articular surface), Physis, and metaphysis
Crush injury of physis with initially normal x-rays and with late identification (premature physeal closure)
  1. Cause of Deformity Appearing shortly (with in months) after trauma
    1. Malunited fracture
  2. With delayed appearance (years) Gradually progressive deformity
    1. Premature closure of physis (epiphyseal injury)
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(Type I)
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(Type II)
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(Type III)
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(Type IV)
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(Type V)
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  1. Ankle Fractures
    1. Fracture of distal tibial and fibula is most common ankle injury and 2nd most commonly physeal fracture second only to distal radial fracture. This is because of horizontal orientation of physis & the strong ligamentous attachment distal to physis.
    2. Most commonly between 10 -15 years of age, & more common in boys and mostly because of fall from height. Injury to the germinal layer of physis (i.e premature closure of physis) leading to asymmetrical or symmetrical growth arrest is the most common complication following distal tibial physeal injury in children.
    3. It is important to follow patients with distal tibial physeal injury closely during the first 2 years after the injury for physeal arrest. In some causes growth arrest can appear more than 2 years after injury, and therefore follow up should extend until near skeletal maturity.
    4. More often require operative intervention than fractures of distal radius & are also more likely to be associated with subsequent premature growth arrest.

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