![]() Factors that affect the risk of problems over time include: The patient's age. Growth plate fractures vary greatly in terms of th risk for growth problems. Salter-Harris type I Salter-Harris type I fractures were thought to be an uncommon type of distal pediatric femur fracture in early studies, accounting for only about 7 percent of distal femur physeal fractures 2. They are also common in the outer bone of the forearm (radius) and lower bones of the leg (tibia and fibula). The Salter-Harris classification of physeal fractures is most often used. The HEEADSSS screening tool may be useful to guide this line of inquiry. Most growth plate fractures occur in the long bones of the fingers. Involvement of medical social worker teams or mental health teams may be necessary. Remember to check Tetanus vaccination status.Ī child/adolescent who presents to the PED with a hand injury because of a fight or an injury mechanism such as punching a wall requires special attention- screening for mental health and/or social problems is paramount. This radiology series demonstrates the first two stages of normal fracture healing: inflammatory and reparative stage. Check integrity of flexor/extensor tendons in the presence of open wounds. Type IV fractures cross the epiphysis, physis, and metaphysis. Type III fractures are intra-articular fractures through the epiphysis that extend across the physis. A Salter-Harris II fracture may be fixed with a lag screw through the metaphyseal (Thurstan Holland) fragment and the metaphysis of the proximal fragment. Substantial injuries or infected open wounds require a surgical opinion as these may require admission for IV antibiotic cover and washout in theatre. Type II fractures involve a break from the growth plate up into the metaphysis, with the periosteum usually remaining intact. Be vigilant for rotational deformity no degree of malrotation is acceptable.Įnsure to evaluate skin integrity over the injured area, check for and document the presence of open wounds, and consider the possibility that these could be so-called ‘’fight bites’’ and will require antibiotics. The child/adolescent will usually present with bruising, swelling and diffuse pain over the dorsum of the hand. ![]()
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