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Fracture Epiphysis

Arthralgias, including skeletal changes such as hyperostoses, tendinous calcifications, premature epiphysial closure, and pathological fractures. [Pg.488]

The proximal humeral epiphysis arises from two, sometimes three separate ossification centres (Fig. 7.12). The first ossification centre develops medially at about 2 weeks of age and the second ossification centre develops in the greater tuberosity between 6-12 months of age. When the arm is internally rotated, the first appearing medial ossification centre is rotated into a lateral position and can give the false impression of shoulder joint disruption. The rare third centre occurs in the lesser tuberosity in the third year of life, and when visualised on the axillary shoulder view, may be mistaken for a fracture. This ossification centre fuses with the shaft of the humerus at 6-7 years of age. The radiolucent proximal physis of the humerus is tented and in various oblique positions can be mistaken for a fracture (Fig. 7.13). The normal bicipital groove in the proximal humerus may simulate periosteal new bone formation (Fig. 7.14). [Pg.94]

Fig. 7.13a,b. AP (a) and axial (b) views of the proximal humerus showing the normal lucent proximal humeral epiphysis, sometimes mistaken for a fracture (arrows)... [Pg.96]

Any epiphysis or apophysis may develop from multiple centres and similarly the epiphysis of the distal radius or ulna may arise from two ossification centres appearing deft or bipartite (Fig. 7.21) (Harrison and Keats 1980). Separate ossification centres for the radial or ulna styloid processes may fuse with the main ossification centre or persist unfused as accessory ossicles into adulthood. In late adolescence or early adulthood remnants of the fusing or fused epiphysis can be mistaken for fractures. These include fine sclerotic or lucent lines and residual epiphyseal spurs (Fig. 7.22). [Pg.97]

Fig. 7.72. Unfused lateral epiphysis of the distal fibula simulating a fracture... Fig. 7.72. Unfused lateral epiphysis of the distal fibula simulating a fracture...
Kump WL (1966) Vertical fractures of the distal tibial epiphysis. AJR Am J Roentgenol 97 676-681... [Pg.117]

Type III In this injury, the fracture line passes through the epiphysis, and then horizontally across the growth plate. This is most commonly seen in children age 10-15, at the distal tibia. It is less frequently seen at the proximal tibia and distal femur (Fig. 10.7). [Pg.151]

Type IV This is a vertically orientated fracture, involving both the epiphysis and the metaphysis, crossing the growth plate (Fig. 10.8). This is most commonly seen in the distal humerus and tibia. As type III and IV fractures pass across the articular cartilage into the joint space, there is a higher incidence of degenerative joint disease if the fracture is not anatomically reduced. [Pg.152]

Fig. 10.9. a Coronal reconstruction CT image of a Salter IV fracture showing the fracture through the distal epiphysis of the tibia, b Sagittal reconstruction CT of the same patient showing the fracture passing though the distal tibial metaphysis... [Pg.153]

Fractures that involve the growth plate, with or without involvement of the adjacent epiphysis and/ or metaphysis, as classified by Salter and Harris, occur most commonly as accidents. The forces which produce these physeal separations are similar to those which produce the CML, but their magnitude is greater (Kleinman and Marks 1998). [Pg.163]

AP and lateral radiographs will typically confirm the diagnosis of a fracture and are also used in the classification. It is important to delineate the direction of the fracture line, the amount of displacement, the degree of varus deformity and the location of the femoral epiphysis. [Pg.202]

Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haid-ukewych GJ (2007) Femoral neck fractures in pediatric patients 30 years experience at a level 1 trauma center. Clin Orthop Relat Res 454 169-173 Southwick WO (1984) Slipped capital femoral epiphysis. J Bone Joint Surg 66 1151... [Pg.206]

SH 11 is the commonest fracture pattern with the metaphyseal fragment often on the lateral (compression) side, due to a valgus force (Fig. 14.5). A direct anterior force will cause a hyperextension injury where the distal epiphysis is displaced anteriorly... [Pg.210]

Fig. 14.7. a AP radiograph showing fracture of the lateral aspect of the proximal tibial epiphysis, b Corresponding coronal CT image demonstrating a more complex fracture pattern within the epiphysis... [Pg.213]

Fig. 14.9. Classification of tibial tuberosity avulsion injuries 1A,1B, separation of the distal portion of the physis 2A,2By the separation involves the ossification centres of the tibial tubercles and tibial epiphysis 3A,3B, fracture/separation of the entire tubercle. In addition, there may be fracturing through the avulsed fragment (type B)... Fig. 14.9. Classification of tibial tuberosity avulsion injuries 1A,1B, separation of the distal portion of the physis 2A,2By the separation involves the ossification centres of the tibial tubercles and tibial epiphysis 3A,3B, fracture/separation of the entire tubercle. In addition, there may be fracturing through the avulsed fragment (type B)...
The distal tibial epiphysis ossifies between 6 and 24 months of age. The medial malleolus appears at 7-8 years and is complete at 10 years. It usually ossifies as a downward extension of the distal tibial ossific nucleus but may develop as a separate centre of ossification and thus be mistaken for a fracture line. The distal tibial physis closes first centrally, then medially and finally anterolaterally (Fig. 15.1), with the entire process lasting about 18 months. This sequence of closure of the distal tibial physis is important in the pattern of transitional fractures (triplane and juvenile Tillaux). Completion of distal tibial physeal closure is at around 14 years in girls and 16 years in boys. [Pg.225]

Dias LS, Tachdjian MO (1978) Physeal injuries ofthe ankle in children classification. Clin Orthop 136 230-233 Ertl JP, Barrack RL, Alexander AH et al (1988) Triplane fracture of the distal tibial epiphysis long term follow-up. J Bone Joint Surg 70A 967-976 Farley FA, Kuhns L, Jacobson JA et al (2001) Ultrasound examination of ankle injuries in children. J Pediatr Orthop 21 604-607... [Pg.236]

Barnett LS (1985) Little league shoulder syndrome proximal humeral epiphyseolysis in adolescent baseball pitchers. J Bone Joint Surg (Am) 67 495-496 Baxter MP, Wiley JJ (1986) Fractures of the proximal humeral epiphysis their influence on humeral growth. J Bone Joint Surg (Br) 68 570-573 Beringer DC, Weiner DS, Noble JS et al (1998) Severely displaced proximal humeral epiphyseal fractures a followup study. J Pediatr Orthop 18 31-37... [Pg.254]

Clinical examination reveals a laterally swollen elbow, tender at the fracture site, which is increased by active flexion of the wrist. Interpretation of the AP and lateral radiographs depend on the degree of ossification of the capitellum and the extent of the displacement. The lesser the degree of ossification, the harder it is to assess the fidl extent of the injury. In infants, where there is no ossification of the distal humeral epiphysis, lateral condylar injury may be confused with physeal separation or dislocation of the joint Physeal separation is the conunonest of these injuries in infants less than 1 year old. Often the only sign of injury is a small sliver of displaced metaphyseal bone. [Pg.267]

Avulsion fractures of the medial epicondyle are seen between the ages of 9 and 15, after the apophysis becomes a separate ossification nucleus from the epiphysis of the distal humerus and before it fuses with the distal humerus. The medial epicondyle is a traction apophysis for the flexor group of forearm muscles, and also serves as an attachment for the ulnar collateral ligaments and the joint capsule. This injury accounts for up to 10% of elbow fractures. [Pg.272]

Partial or non-displaced with fracture line not extending completely through the epiphysis. [Pg.274]

The Metacarpals 289 Metacarpal Epiphysis and Physis 289 Metacarpal Ne Fractures 290 Metacarpal Shaft Fractures 290 Fractures of the Base of the Metacarpal 290 Metacarpophalangeal Dislocations 291 Carpometacarpal Dislocations 291... [Pg.283]

Extensor hood central slip avulsion fractures are rare, and are visualised as tiny bony avulsions from the dorsal surface of the epiphysis at the hase of the middle phalanx. Displaced bony fragments require internal fixation. Bison s test (Elson 1986) will demonstrate central slip integrity. If the extensor slip is ruptured, the child will be unable to extend the PIPJ of the injured finger if the MCPJs are flexed to 90 degrees over the edge of a table. [Pg.288]

Fractures involving the epiphysis and physis of the finger metacarpals are uncommon (Mahabir et al. 2001). Epiphyseal fractures are rare, and non displaced fractures may heal well (Fig. 19.19). Displaced split fractures of the epiphysis may need open reduction to restore articular congruity (Graham and Waters 2001). Intra-articular fractures of the epiphysis are important to identify as they are associated with joint effusions. If these effusions are under enough pressure, blood flow to the epiphysis maybe sufficiently compromised to cause avascular necrosis. Preventative joint aspiration may be considered (McElfresh and Dobyns 1983). [Pg.289]

Salter RB, Harris WR (1963) Injuries involving the epiphyseal plate. J Bone Joint Surg Am 45-A 587-622 Sandzen SC (1973) Fracture of the fifth metacarpal resembling Bennett s fracture. Hand 5 49-51 Seymour N (1966) Juxta-epiphysial fracture of the terminal phalanx of the finger. J Bone Joint Surg Br 48 347-349 Vadivelu R, Dias JJ, Burke ED, Stanton J (2006) Hand injuries in children a prospective study. J Pediatr Orthop 26 29-35... [Pg.300]


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See also in sourсe #XX -- [ Pg.213 ]




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