Physeal Fracture

A physeal fracture, also known as a growth plate fracture, is a type of injury that occurs in the bones of children and adolescents. The physis, or growth plate, is a layer of cartilage located at the ends of long bones, responsible for bone growth and development.

Causes and Risk Factors

Physeal fractures can occur due to various reasons, including:

• Trauma or injury, such as a fall or blow to the affected area
• Overuse or repetitive stress on the bone, common in young athletes
• Weak or fragile bones, often seen in conditions like osteogenesis imperfecta

Classification

Physeal fractures are classified into five types, based on the severity of the injury:

• Type I: A slip of the epiphysis (end of the bone) from the metaphysis (shaft of the bone), with no fracture through the growth plate
• Type II: A fracture through the growth plate and metaphysis, with the epiphysis remaining intact
• Type III: A fracture through the growth plate and epiphysis, extending into the joint
• Type IV: A fracture through all three elements: the epiphysis, growth plate, and metaphysis
• Type V: A compression or crush injury to the growth plate, without an associated fracture

Symptoms and Diagnosis

Symptoms of a physeal fracture may include:

• Pain and swelling in the affected area
• Limited mobility or stiffness in the joint
• Deformity or abnormal alignment of the bone

Diagnosis is typically made through a combination of:

• Physical examination and medical history
• X-rays to visualize the bone and growth plate
• CT or MRI scans for more detailed imaging, if necessary

Treatment and Management

Treatment for physeal fractures depends on the severity of the injury and may include:

• Immobilization with a cast or splint to allow healing
• Pain management with medication
• Surgical intervention, such as reduction and internal fixation, for more severe fractures
• Physical therapy to restore mobility and strength after healing

Complications and Prognosis

Physeal fractures can lead to complications, including:

• Growth disturbances or arrest, resulting in uneven bone growth
• Deformity or angulation of the bone
• Arthritis or joint problems in later life

The prognosis for physeal fractures varies depending on the severity of the injury and effectiveness of treatment. With proper management, most children can expect a full recovery and normal bone growth.