文摘
Fractures involving the physis account for up to one-third of paediatric fractures. It is also the structure which needs to be preserved to ensure normal growth. The relative strength of the physis changes with age and it becomes weaker as the child grows older, making physeal injuries more common in adolescence. It is important to understand the physeal anatomy and its relevance to different types of physeal injuries. Salter–Harris system is a clinically useful approach to classifying and describing physeal injuries. Each physeal injury should be treated as a distinct entity taking into account the patient's age, location of injury, type of injury, growth potential of the affected part, degree of displacement and time elapsed since injury. Its treatment ranges from conservative management to operative fixation. Manipulation of physeal fractures should be as gentle as possible to prevent growth plate damage leading to growth disturbances. These complications can be difficult and complex to manage. The management involves two phases: the first phase should ensure reduction, maintenance of reduction, and bone healing; the second phase involves monitoring the growth with long-term follow-up, to detect any deformities from growth arrests or disturbances. Counselling parents about the potential risk of future growth arrest and deformity is important.
