Management of disordered growth following physeal injury

Abstract

The growth plates are dynamic structures responsible for the dramatic change of body proportions between the embryo and adult. For example, the whole trunk and lower limbs represent half the length of the 3-month-old embryo whereas, as a result of growth, the legs alone contribute to half the adult height. Injury to a growth plate may result in a short, deformed limb. Fortunately, most growth plate injuries do not produce adverse long-term sequelae. The different patterns of growth plate injury have been classified by Salter and Harris (1963). Those with a good, long-term prognosis involve a transverse cleavage through the zone of hypertrophy, usually associated with a separated small marginal fragment of metaphysis. Those injuries with an adverse effect on growth are splitting injuries across the physis (@p-es la and la), or those causing damage to the epiphyseal blood supply. Although a crushing or longitudinal compression force has been described as causing growth arrest (type V, Salter and Harris, 1963) this theory is in dispute (Peterson and Burkhart, 1981). It is important to stress that appropriate initial reduction and internal fixation of the displaced splitting injuries can, in most cases, prevent the long-term adverse sequelae. However, some injuries associated with irreversible damage to the growth plate may not be apparent on the early radiographs. If a bone bridge forms between the metaphysis and epiphysis there is premature arrest of growth. This is usually localized to one part of the physis and results either in progressive shortening (F&m-e lb), or a combination of shortening and progressive deformity (F&m Zb,c, and Figure 3~).