From the Research
The vertical fracture passing through the physis and exiting through the metaphysis is consistent with a Salter-Harris type II fracture. This type of fracture is the most common type of growth plate fracture in children, accounting for approximately 75% of all physeal injuries 1. The fracture line extends through the growth plate and then turns to exit through a portion of the metaphysis, creating a triangular metaphyseal fragment sometimes called the "Thurston-Holland sign." Salter-Harris type II fractures generally have a good prognosis because the blood supply to the epiphysis remains intact, reducing the risk of growth disturbance.
Key Characteristics of Salter-Harris Type II Fractures
- The fracture line passes through the growth plate and exits through the metaphysis
- The blood supply to the epiphysis remains intact, reducing the risk of growth disturbance
- The fracture is the most common type of growth plate fracture in children, accounting for approximately 75% of all physeal injuries
Treatment and Management
Treatment typically involves closed reduction and immobilization with a cast for 4-6 weeks, though some cases may require surgical fixation if the reduction cannot be maintained 1. Close follow-up is essential to monitor for potential complications such as growth arrest, angular deformity, or limb length discrepancy. High clinical suspicion is required to diagnose these rare injuries, and when in doubt, MRI is advocated to better delineate the fracture as the potential complications can be limb-threatening. Anatomical reduction and adequate immobilization should be done to prevent deformities and achieve a good functional outcome in the long term.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment are crucial to prevent long-term complications and ensure optimal outcomes. The proximity of the popliteal artery puts this region at an increased risk of vascular injury and compartment syndrome, and premature closure of the growth plate can cause restrictions in growth and angular malformations 1. Therefore, frequent monitoring and further testing should be done to better diagnose these injuries and initiate prompt treatment.