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1、Jean-MarcGauguet,HMSIVGillianLieberman,MDRadiologyofPediatricFracturesJean-MarcGauguet,HMSYearIVGillianLieberman,MD9/14/06Jean-MarcGauguet,HMSIVGillianLieberman,MDOverview•Osteology•Salter-HarrisFractures•GreenstickFractures•TorusFracturesJean-MarcGa
2、uguet,HMSIVGillianLieberman,MDLongitudinalBoneGrowthProvisionalCalcificationHypertrophingProliferatingRestingModifiedfrom:PediatricFracturesandDislocationshttp://www.unu.edu/Unupress/food2/UID06E/uid06e0u.htm•Thephysisisdividedintometaphysealandepiph
3、ysealsections.•Mitosisofchondrocytesintheepiphysealsectionandgrowthinthemetaphysealsectionleadstolongitudinalgrowth.•Therestingandproliferatingzonescontainhighamountsofchondoitinsulfate,whichimpartsstrength.•Thehypertrophingzonelackschondroitinsulfat
4、eorcalciumandistheweakestlayer-thisisthesiteofphysealfractures.Jean-MarcGauguet,HMSIVGillianLieberman,MDKidsbonesarespecial•Epiphysealgrowthplatesinchildrenhavenotcompletelyossified.•Theperiostiuminchildrenisthicker,moremetabolicallyactive,lesseasily
5、torn,andmoreeasilystrippedfromthebone.Jean-MarcGauguet,HMSIVGillianLieberman,MDEndplateClosure•Priortoendplateclosurethereisabalancebetweenchondrocyteproliferationandbonemineralization.•Onceproliferationslowsandceasesmineralizationcanbecompleted.•End
6、plateclosureoccurswhenmineralizationPediatricFracturesandDislocationscrossedintotheepiphysis.Jean-MarcGauguet,HMSIVGillianLieberman,MDSalter-Harris(SH)Overview•Developed5levelclassificationsystemin1963.•Fractureinvolvinginjurytothephysisoflongbonesbe
7、forecompleteclosureoccurs.•35%ofallskeletalinjuriesinchildren.•75%ofcasesoccurinkidsbetween10-15years.•Mostcommonsites:wrist50%,ankle30%.•Thegrowthplateis2-5timesweakerthanjointcapsuleorligaments.Jean-MarcGauguet,HMSIVGillianLieberman,MDTypeI•Lineofc
8、leavageconfinedtothephysis.•Accountsfor6%ofcases.•Mostcommonlyoccursinthephalanges.•Growthdisturbanceuncommonbecausegerminallayerandvesselsnotdisturbed.•Excellentprognosis,treatwithclosedreductionandimmobilization.•Patientsoftentreatedifnoovertsignso