Epiphyseal Growth Plate Fractures

This comprehensive reference work covers all aspects of growth plate
fractures and their complications. Following general reviews of
growth plate fractures, 21 chapters deal with each epiphyseal growth
plate in the body. All of these chapters are constructed similarly
for easy and quick retrieval of the required information. The main
emphasis is on evaluation (diagnosis) and management (treatment). A
separate section is devoted to premature partial physeal arrest, as
this is by far the most common and feared complication of a growth
plate fracture and its treatment is involved and controversial. The
case studies included are often based on 20- to 30-year follow-ups,
revealing cases that originally appeared to be quite satisfactory at
the conclusion of growth but were found to have turned out quite
poorly years later. This unique text is an essential and excellent
resource for any pediatric orthopedic surgeon as well as all
personnel in the emergency room.

XIII
Contents

PART I
Physeal Fractures: General Considerations

Chapter 1
Historical Review
Prior to the Twentieth Century.. . . . . . . . . . . . . . . . . . 3
The Twentieth Century... .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5
References.. . . . . . . . . . . . . . . . . . .. . . . . . . . . . 6

Chapter 2
Anatomy and Growth
History... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7
Anatomy ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Growth.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Chapter 3
Classification
Introduction.. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Bergenfeldt 1933 ..... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .22
Aitken 1936. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... ..22
Brashear 1958... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .22
Salter and Harris 1963. .. .. .. .. .. .. .. .. .. .. .. .. ... ..25
Rang 1969 ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .27
Ogden 1981. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... ..27
Shapiro 1982 . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... ..27
Peterson 1994... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .28
Anatomy .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Epidemiology... .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .28
Fracture Type, Age, and Site ... .. .. .. .. .. .. .. .. .. .. .. .28
Prognosis. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..28
Complications .. . . . . . . . . . . . . . . . . . . . . . . . . . 28
A Type 1 Fracture.. . . . . . . . . . . . . . . . . . . . . . . . 30
Anatomy .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Classification . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..32
Epidemiology... .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .33
Evaluation... .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .35
Management ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .44
Complications .. . . . . . . . . . . . . . . . . . . . . . . . . . 44
B Type 2 Fracture.. . . . . . .. . . . . . . . . . . . . . . . . . 49
Anatomy .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Classification . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..49
Epidemiology... .. .. .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .50
Evaluation... .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .51
Management ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .51
Complications .. . . . . . . . . . . . . . . . . . . . . . . . . . 56
C Type 3 Fracture.. . . . . . .. . . . . . . . . . . . . . . . . . 58
Anatomy .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Classification . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..58
Epidemiology... .. .. .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .58
Evaluation... .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .