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Physeal Fractures
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Salter-Harris (SH) fractures 1-5 (I-V)
            • Definitions

              • Fracture of immature skeleton involving cartilaginous primary growth plate (physis)

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Reporting Tips

                                          Selected References

                                          1. Chen J et al: Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture. Skeletal Radiol. 44(10):1547-51, 2015
                                          2. Mayer S et al: Pediatric knee dislocations and physeal fractures about the knee. J Am Acad Orthop Surg. 23(9):571-80, 2015
                                          3. Wang DC et al: Imaging of physeal bars in children. Pediatr Radiol. 45(9):1403-12, 2015
                                          4. Abzug JM et al: Physeal arrest of the distal radius. J Am Acad Orthop Surg. 22(6):381-9, 2014
                                          5. Little JT et al: Pediatric distal forearm and wrist injury: an imaging review. Radiographics. 34(2):472-90, 2014
                                          6. Fassier A et al: Fractures in children younger than 18 months. Orthop Traumatol Surg Res. 99(1 Suppl):S160-70, 2013
                                          7. Gufler H et al: MRI for occult physeal fracture detection in children and adolescents. Acta Radiol. 54(4):467-72, 2013
                                          8. Podeszwa DA et al: Physeal fractures of the distal tibia and fibula (Salter-Harris Type I, II, III, and IV fractures). J Pediatr Orthop. 32 Suppl 1:S62-8, 2012
                                          9. Raman S et al: MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture. Pediatr Radiol. 41(12):1591-4, 2011
                                          10. Dwek JR: The periosteum: what is it, where is it, and what mimics it in its absence? Skeletal Radiol. 39(4):319-23, 2010
                                          11. Lippert WC et al: Salter-harris type III fractures of the distal femur: plain radiographs can be deceptive. J Pediatr Orthop. 30(6):598-605, 2010
                                          12. Schurz M et al: Physeal injuries of the distal tibia: long-term results in 376 patients. Int Orthop. 34(4):547-52, 2010
                                          13. Soulier R et al: Irreducible Salter Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon: a case report. J Foot Ankle Surg. 49(4):399, 2010
                                          14. Basener CJ et al: Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma. 23(9):663-7, 2009
                                          15. Laor T et al: Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol. 186(5):1260-4, 2006
                                          16. Ecklund K et al: Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol. 178(4):967-72, 2002
                                          17. Ecklund K et al: Imaging of growth disturbance in children. Radiol Clin North Am. 39(4):823-41, 2001
                                          18. Carey J et al: MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol. 27(5):250-5, 1998
                                          19. Ogden JA: Injury to the growth mechanisms of the immature skeleton. Skeletal Radiol. 6(4):237-53, 1981
                                          20. Salter RB et al: Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 45:587-622, 1963
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Salter-Harris (SH) fractures 1-5 (I-V)
                                                    • Definitions

                                                      • Fracture of immature skeleton involving cartilaginous primary growth plate (physis)

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Chen J et al: Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture. Skeletal Radiol. 44(10):1547-51, 2015
                                                                                  2. Mayer S et al: Pediatric knee dislocations and physeal fractures about the knee. J Am Acad Orthop Surg. 23(9):571-80, 2015
                                                                                  3. Wang DC et al: Imaging of physeal bars in children. Pediatr Radiol. 45(9):1403-12, 2015
                                                                                  4. Abzug JM et al: Physeal arrest of the distal radius. J Am Acad Orthop Surg. 22(6):381-9, 2014
                                                                                  5. Little JT et al: Pediatric distal forearm and wrist injury: an imaging review. Radiographics. 34(2):472-90, 2014
                                                                                  6. Fassier A et al: Fractures in children younger than 18 months. Orthop Traumatol Surg Res. 99(1 Suppl):S160-70, 2013
                                                                                  7. Gufler H et al: MRI for occult physeal fracture detection in children and adolescents. Acta Radiol. 54(4):467-72, 2013
                                                                                  8. Podeszwa DA et al: Physeal fractures of the distal tibia and fibula (Salter-Harris Type I, II, III, and IV fractures). J Pediatr Orthop. 32 Suppl 1:S62-8, 2012
                                                                                  9. Raman S et al: MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture. Pediatr Radiol. 41(12):1591-4, 2011
                                                                                  10. Dwek JR: The periosteum: what is it, where is it, and what mimics it in its absence? Skeletal Radiol. 39(4):319-23, 2010
                                                                                  11. Lippert WC et al: Salter-harris type III fractures of the distal femur: plain radiographs can be deceptive. J Pediatr Orthop. 30(6):598-605, 2010
                                                                                  12. Schurz M et al: Physeal injuries of the distal tibia: long-term results in 376 patients. Int Orthop. 34(4):547-52, 2010
                                                                                  13. Soulier R et al: Irreducible Salter Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon: a case report. J Foot Ankle Surg. 49(4):399, 2010
                                                                                  14. Basener CJ et al: Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma. 23(9):663-7, 2009
                                                                                  15. Laor T et al: Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol. 186(5):1260-4, 2006
                                                                                  16. Ecklund K et al: Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol. 178(4):967-72, 2002
                                                                                  17. Ecklund K et al: Imaging of growth disturbance in children. Radiol Clin North Am. 39(4):823-41, 2001
                                                                                  18. Carey J et al: MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol. 27(5):250-5, 1998
                                                                                  19. Ogden JA: Injury to the growth mechanisms of the immature skeleton. Skeletal Radiol. 6(4):237-53, 1981
                                                                                  20. Salter RB et al: Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 45:587-622, 1963