Distal fibula fracture4/5/2023 Since the epiphysis is involved, damage to the articular cartilage may occur. If the fracture extends the complete length of the physis, this type of fracture may form two epiphyseal segments. This is an intra-articular fracture extending from the physis into the epiphysis. If it involves the distal end of the bone, the physis is distal to the metaphysis, which extends proximally from the physis into the metaphysis. If the proximal end of the bone is involved, the physis is proximal to the metaphysis, so this extends distally from the physis into the metaphysis. When the small corner of the metaphysis is visible, this is known as a corner sign or Thurston-Holland fragment.īe careful in using the terms proximal and distal to describe the extension because the position of the physis is relative to the metaphysis and is not fixed. These are most common and occur away from the joint space. These are when the fracture extends through both the physis and metaphysis. An example is Slipped Capital Femoral Epiphysis (SCFE). Diagnosis is based on clinical findings, such as the presence of focal tenderness or swelling surrounding the growth plate. Look for the widening of the physis or displacement of the epiphysis, which may suggest a fracture. A radiograph may be normal due to lack of bony involvement, and mild to moderate soft tissue swelling may be noted. Beware that a normal radiograph cannot exclude a physis injury in a symptomatic pediatric patient. Type I fractures are due to the longitudinal force applied through the physis, which splits the epiphysis from the metaphysis. This is when the fracture line extends through the physis or within the growth plate. Higher-grade Salter-Harris fractures have a higher incidence of premature physeal fusion. Ranging from I to V, lower numbers are less severe and have less of a propensity for growth abnormalities. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting March 24-28, 2020 (meeting canceled).ĭisclosure: Beck reports she is a board or committee member of POSNA and of Pediatric Research in Sports Medicine.Salter-Harris fractures include a classification system that allows providers to risk-stratify injuries. removable boot is currently underway to determine optimal treatment of these injuries.” – by Casey Tingleīeck J, et al. A POSNA-funded randomized study on the effect of cast vs. removable boot) may influence complication rate and patient satisfaction. “The most common complication related to treatment was cast related complications, indicating choice of immobilization (cast vs. “Although complications are rare from this injury, POSNA members do report complications such as late displacement, nonunion, growth arrest and most commonly chronic pain, possibly resulting in CRPS/RSD,” Beck told Healio Orthopedics. Results showed 81.2% of POSNA members reported no complications from Salter-Harris 1 distal fibula fracture treatment and 87.8% reported no complications from ankle sprain treatment among pediatric patients. Researchers noted growth arrest and continued pain/reflex sympathetic dystrophy as other reported ankle sprain complications. Results showed other reported complications with Salter-Harris 1 fractures included persistent pain/reflex sympathetic dystrophy, distal fibular growth arrest, infection, nonunion and recurrent fracture. Researchers noted 9.6% and 5.2% of respondents reported having seen a cast complication in Salter-Harris 1 distal fibula fracture treatment and ankle sprain treatment, respectively, compared with 0.4% reported having seen a brace complication in both Salter-Harris 1 fractures and ankle sprains. For ankle sprain treatment, 45% preferred the CAM boot, 18% preferred a stirrup brace, 14.5% preferred an over-the-counter brace and 11% preferred a cast, according to results. Researchers found 54% of respondents preferred controlled ankle movement (CAM) boot immobilization and 34% preferred cast immobilization for Salter-Harris 1 distal fibula fracture treatment. Of the 16.4% of POSNA members who completed the survey, results showed 81.2% reported no complications from Salter-Harris 1 distal fibula fracture treatment and 87.8% reported no complications from ankle sprain treatment. Beck, MD, and colleagues surveyed 1,400 members of the Pediatric Orthopaedic Society of North America to identify treatment complications and rare complications of ankle sprains and non-displaced Salter-Harris 1 distal fibula fractures in skeletally immature patients.
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