Pediatric disorders Flashcards
(200 cards)
1
Q
Osteogenesis Imperfecta
A
- “Brittle bone disease”
- Defect in maturation & organisation of type I collage.
- Autosomal dominant
2
Q
Features of Osteogenesis Imperfecta
A
- Multiple fragility fractures in childhood, short stature, blue sclerae, loss of hearing
- Osteopenia, thin (gracile) bones.
- Fractures heal with poor quality callus
3
Q
What symptoms are associated with skeletal dysplasia?
A
Learning difficulties; spine deformity; limb deformity; internal organ dysfunction; cranio facial abnormalities; skin abnormalities; tumour formation; joint hypermobility; atlanto-axial subluxation; spinal cord compression and intrauterine or premature death
4
Q
Achondroplasia
A
Autosomal dominant condition with disproportionately short limbs with prominent forehead and widened nose. Lax joints and normal mental development. A form of short-limbed dwarfism
5
Q
Marfan’s syndrome
A
An inherited disease that affects your body’s connective tissue, which gives strength, support, and elasticity to tendons, cartilage, heart valves, blood vessels, and other vital parts of your body
Mutation of fibrillin gene
- Tall stature and ligamentous laxity, scoliosis, joint instability, pectus excavatun
6
Q
Ehlers-Danlos Syndrome
A
- Autosomal dominant condition with abnormal elastin and collagen formation
- Joint hypermobility, vascular fragility, joint instability and scoliosis
- risk of bleeding (vascular fragility)
7
Q
Down syndrome
A
- Trisomy 21
- Short stature, joint laxity, recurrent dislocation (patella)
- Atlanto-axial instability in the c-spine
8
Q
Spina bifida
A
Congenital neural tube defect in which the two halves of the posterior vertebral arch fail to fuse - baby’s spine does not form normally. As a result, the spinal cord and the nerves that branch out of it may be damaged.
Two main types – spina bifida occulta & spinabifida cystica
9
Q
Spina bifida occulta
A
- Mild form. May have no associated syymptoms
- Tethering of spinal cord and roots causing pes cavus (high arched foot) and clawing of toes. Neurological symptoms at any age
- Tuft of hair or dimple in skin overlying the defect
10
Q
Spina bifida cystica
A
More severe form. Contents of vertebral canal herniate through the defect. Can be just meninges (meningocele) or spinal cord/cauda equina (myelomeningocele) itself
Meningocele not associated with neurological symptoms. Myelomenigocele associated with neurological deficit below the lesion.
Associated with hydrocephalus
Degree of disability depends on spinal level affected.
11
Q
Polio/ poliomyelitis
A
Viral infection affecting motor anterior horn in spinal cord or brainstem resulting in lower motor neurone deficite
12
Q
Syndactyly
A
Most common. Two digits are fused to failure of separation of skin and soft tissue of adjacent digits. Surgical separation indicated
13
Q
Polydactyly
A
Extra digit. Amputation
14
Q
Fibular hemimelia
A
Complete or partial absence of fibular. Leads to shortened limb, bowing of tibia and ankle deformity.
15
Q
Management of Fibular hemimelia
A
Limb lengthening in mild cases. Amputation and below knee prosthetics in more severe cases
16
Q
Most common limb deformity
A
Syndactyly
17
Q
Erb’s palsy
A
- Injury to C5 & C6
- Loss of innervation to deltoid, supraspinatus, infraspinatus, biceps and brachialis muscle.
- Internal rotation of humerus
18
Q
Klumpke’s palsy
A
- Injury to C8 & T1 caused by forceful adduction
- Paralysis of intrinsic muscles of hand, wrist flexors
- Fingers flexed
- Poor prognosis
19
Q
Sits alone, crawls
A
6‐9 months
20
Q
Child stands
A
8-12 months
21
Q
Child walks
A
14‐17 months
22
Q
Child jumps
A
24 months
23
Q
Child manages stairs independently
A
Age 3
24
Q
Loss of primitive reflexes (Moro reflex, stepping reflex, rooting, grasp reflex, fencing posture etc)
A
1‐6 months.
25
Child gains head control
2 months
26
Child speaks a few words
9‐12 months
27
Child stacks 4 blocks
18 months
28
Child potty trained
2‐3 years
29
Child understands 200 words, learns around 10 words/day
18‐20 months
30
What is Genu varum?
Bow legs - Growth disorder of the medial proximal tibial physis.
Other causes include: rickets, tumour, traumatic physeal injury, skeletal dysplasia.
31
What risk is associated with Genu varum?
Risk of early onset medial compartment osteoarthritis
32
Genu valgum
Also known as Knock-knees is associated with rickets, tumour, trauma and neurofibromatosis
33
In-toeing
When walking and standing, feet point toward the midline.
34
Causes of in-toeing
* Femoral neck anteversion
* Internal tibial torsion
* Forefoot adduction
35
Flat feet
Part of normal variation. Some people have it without any functional problem
36
Jack test
To distinguish between mobile or fixed flat feet.
37
Curly toes
* Minor overlapping of the toes and curling of toes.
* Fifth toe most frequently affected
* May cause discomfort in shoes.
38
Curly toes treatment
Persistent cases in adolescence may require surgical correction
39
Patellar tendonitis
Patellar tendinitis )i.e Jumper's knee) is an injury to the tendon connecting your kneecap (patella) to your shinbone. (Inflammation of the patellar tendon)
40
Apophysitis
Inflammation of a growing tubercle where a tendon attaches.
41
Osgood-Schlatter’s disease
Tibial tubercle apophysis
A condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the tibia, a spot called the tibial tuberosity.
42
Patellofemoral dysfunction
* Common in adolescenet GIRLS
* Due to muscle imbalance, ligamentous laxity, subtle skeletal predisposition (valgum, wide hips, femoral neck anteversion)
* Chondromalacia patellae may be present
43
Chondromalacia
Condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens
44
Patellar instability
Dislocation & subluxation of patella. May be related to trauma and tear in medial patellofemoral ligament
Dislocation may cause osteochondral fracture. Small fragments may be recovered by arthroscopic surgery. Large fragments – fixation
45
Osteochondritis dissecans (OCD)
1. Fragment of hyaline cartilage with some bone fragments breaks off the surface of the joint
2. Poorly localised pain, effusion and locking
3. Predisposes to OA.
46
Osteochondritis dissecans (OCD) management
Loose fragments require removal. Lesions at risk of breaking – fixation
47
Patellar instability management
Many patients stabilise as they grow older. Recurrent dislocation may require surgery
48
Talipes Equinovarus
Clubfoot
Congenital deformity due to in-utero abnormal alignment of the joints between the talus, calcaneus and navicular.
49
Treatment of Talipes Equinovarus
* Early splintage
* 80% of children require a tenotomy of the achilles tendon to maintain full correction
* Surgery indicated in resistant to splintage
50
Tarsal Coalition
Abnormal bridge between the calcaneus and navicular or between talus and calcaneus.
Can lead to painful fixed flat foot deformity in older children
51
Hallux valgus
Also called bunions - grow on side of foot
52
Spondylolisthesis
* Slippage of one vertebra over another – usually L4/5 or L5/S1,
* Due to developmental defect or recurrent stress fracture
53
Waddling gait
Spondylolisthesis (vertebrae slippage out of place)
54
Features of Spondylolisthesis
Low back pain and radiculopathy.
• Paradoxical flat back due to spasm
• Waddling gait
55
Avascular necrosis
Loss of blood supply to a bone - temporary or permanent
56
Trochanteric Bursitis/gluteal cuff syndrome
Inflammation of the bursa at the lateral point of the hip known as the greater trochanter
57
What are the 4 ligaments of the knee?
ACL
PCL
MCL
LCL
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ACL
Prevent abnormal internal rotation of the tibia
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PCL
Prevents knee hyperextension and anterior translation of femur
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MCL
Resists valgus force
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LCL
Resists varus force and abnormal external rotation of the tibia
62
Meniscal injury features
Twisting force on a loaded knee (Turning at football, squatting)
• Localized pain to medial or lateral joint line
• Effusion following day
• Catching or locking sensation
• 15 degree springy block to full extension. Difficulty straightening knee to full extension – meniscus full torn, flipping over and getting stuck in joint line)
• Knees may feel about to give way
• Positive steinman’s test
63
Steinman’s test
Test done to diagnose meniscal pathology at the knee joint.
64
What meniscal injury is most common?
Medial more common than lateral
65
Bucket handle meniscal tear
Large meniscal fragment flips out its normal position and displaces anteriorly or into intercondylar notch. Knee locking occurs due to mechanical extension
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Degenerative meniscal tears
* Occurs as meniscus weakens with age.
* Tends to have complex patterns
* Often first stage of knee osteoarthritis.
* Steinman negative
67
Treatment of meniscal tears
Poor healing potential as limited blood supply. Healing potential also decreases with age and time from injury
1. Meniscal repair – suturing meniscus to its bed. 25% fail and require arthroscopic menisectomy
2. Arthroscopic menisectomy - removal of some or all of the meniscus
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Why do meniscal tears require surgery?
Poor healing potential as limited blood supply. Healing potential also decreases with age and time from injury
69
ACL rupture cause
High rotational force. Internal rotation of tibia. Turning upper body laterally on a planted foot
70
Features of ACL rupture
* “pop” heard.
* Haemarthrosis within an hour of injury
* Deep pain in knee
* Rotary instability with knee giving way when turning on a planted foot
71
Treatment of ACL rupture
* Physiotherapy
* ACL reconstruction with tendon graft
* Indicated for sportspersons or those whose knees give way on sedentary activity. Extensive rehabilitation indicated
72
What tendons are used for ACL rupture repair?
Patellar, semitendinosis or gracilis
73
When is surgery indicated for ACL rupture repair?
Indicated for sportspersons or those whose knees give way on sedentary activity. Extensive rehabilitation indicated
74
PCL rupture
* Unlikely to occur in isolation.
* if your shinbone is hit hard just below the knee or if you fall on a bent knee. These injuries are most common during: Motor vehicle accidents
75
MCL tear
* Fairly common.
* Laxity & pain on valgus stress. Tenderness over origin or insertion of MCL
MCL prevents leg from extending too far inwards
76
LCL tear
Most often occur from a direct blow to the inside of the knee. This can stretch the ligaments on the outside of the near too far and may cause them to tear
77
MCL tear management
1. Acute – high knee brace
| 2. Chronic – MCL tightening or reconstruction
78
LCL tear management
Treatment – Surgical with tendon graft
LCL helps to prevent excessive side (lateral) movement of the knee joint.
79
What nerve is commonly injured in LCL tears?
High incidence of common peroneal nerve injury from excessive stretch
80
Extensor Mechanism ruptures
Rupture involving tibial tuberosity, patellar (more common in younger), quadriceps (more common in older) tendon and quadriceps muscles.
81
Cause of Extensor mechanism ruptures
Due to rapid contractile force (after lifting heavy weight or fall or denegenerate tendon)
- trauma, degenerative disease, overuse injuries
82
Predisposing factors for developing extensor mechanism ruptures
Tendonitis; steroid use; diabetes, RA & chronic renal failure
83
Patellofemoral dysfunction
* Disorders of patellofemoral articulation resulting in anterior knee pain
* Due to lateral pull of the patella.
* More common in females.
84
Valgus stress injury
* Tear medial collateral.
| * Higher forces potential damage ACL and risk of lateral tibial plateau fracture
85
Arthrodesis
Surgical stiffening or fusion of a joint in a position of function
Useful in endstage ankle arthritis, wrist arthritis and arthritis of first MTP
86
Osteotomy
* Surgical realignment of a bone
| * Useful for correction of deformity or to shift the load on an arthtitic limb
87
Arthroplasty
Restores function of a joint - Can be made from stainless steel, cobalt chrome, titanium alloy, polyethylene and ceramic
• Will eventually fail due to loosening or breakage
88
Brodie’s abscess in osteomyelitis
bone reacts by walling off abcess with a thin rim of sclerotic bone
89
What organisms cause surgical infections?
Usually Staph aureus and gram neg bacilli
Do not give antibiotics until surgical decision has been reached
90
Another name for frozen shoulder
Adhesive Capsulitis
91
Adhesive Capsulitis
Progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after 18-24 months due to capsule and glenohumeral ligaments becoming inflamed, thicken and then contract
92
Tears in glenoid labrum
* SLAP lesions
* Diagnoses using MRI arthrogram
* Treatment – biceps tenotomy or labral resection
93
Popeye deformity
Spontaneous rupture of bicep
94
Ganglion
A ganglion cyst is a fluid-filled swelling that usually develops near a joint or tendon - Cause localised pain or irritation
95
Foot drop
Common fibular nerve (pernoeal nerve)
96
Positive anterior drawer test
Tibia can be pulled forward easily when knee flexed) due to ACL tear/rupture
97
Painful arc (pain on abducting between about 70 and 120 degrees)
Shoulder impigement, Damaged supraspinatus tendon, frozen shoulder
98
Locked knee
bucket handle meniscal tear
99
Bamboo spine on xray, scoliosis, Question mark posture
Ankylosing spondylitis
100
Popcorn calcification on xray
chondrosarcoma
101
Sunray calcification on xray
Osteosarcoma
102
Onion-peel” sign
Ewing’s sarcoma
103
Management of Infection in prosthetic joints
o Ideally, remove prosthetics and cement
o Re-implantation of joint after aggressive antibiotics therapy
o Treatment for staph epidermidis is vancomycin
104
Gas gangrene
o Bacterial infection that produces gas in tissues with gangrene
o Spores, found in soil
o Treat with urgent debridement
105
Necrotising fasciitis
o Severe infection of either the dermis, subcutaneous tissue, fascia or muscle
o Surgical emergency
Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia. Quickly spreads
106
Necrotising fasciitis management
1. Debridement
2. Penicillin (kills bacteria during exponential growth phase)
3. Clindamycin (switches off bacterial toxin production during stationary phase)
107
What are the normal curves of the spine?
o Cervical lordosis
o Thoracic kyphosis
o Lumbar lordosis
108
Paronychia
infection within nail field
109
Bursitis
Bursitis is where a bursa becomes swollen and inflamed. A bursa is a small, fluid-filled sac that acts like a cushion between tendons and bones.
110
Hallux rigidus
stiff great toe
111
Multiple myeloma
Multiple myeloma is a cancer of the plasma cells, which accumulate in the bone marrow. It commonly causes bone pain in the ribs and spine, anaemia and renal failure
112
What shoulder dislocation is most common?
Anterior shoulder dislocation is much more common than posterior dislocation
113
What dislocation can arise from a seizure?
Shoulder dislocation
114
Axillary nerve damage signs
Principle sign of axillary nerve damage is loss of sensation in regimental badge area
115
Shoulder dislocation management
Treat with closed reduction under anaesthetic
116
Olecranon fracture
o Occur with fall onto the elbow
| o Treat with ORIF
117
Monteggia fracture
A fracture of the proximal third of the ulna with dislocation of the proximal head of the radius.
118
Galeazzi fracture
fracture of the middle to distal third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ).
119
Colles fracture
Extra-articular fracture of the distal radius with dorsal displacement
Broken wrist - similar to Smith’s but smith does not extend to wrist
Occurs due to a FOOSH - Median nerve compression and carpal tunnel may be a feature
120
Smith's fracture
o Extra-articular fracture of the distal radius with volar displacement
o Occurs due to fall onto the back of a flexed wrist (opposite of a FOOSH)
o Treat with ORIF
121
Barton's fracture
o Intra-articular fracture of the distal radius
| o Treat with ORIF
122
Scaphoid fracture
```
o Usually occurs after FOOSH
o Tenderness in the anatomical snuff box
o Difficult to visualise on xray
o Treat with plaster cast to immobilise the wrist while healing occurs
o If displaced, ORIF
```
123
Baker's cysts
Is a fluid filled swelling at the back of the knee
124
McMurray's test
Used to detect internal tears in the knee joint. It is a procedure by which the knee is systemically rotated to identify where tears in the cartilage (called the meniscus) may have occurred or developed.
125
Rheumatoid factor for RA
> Sensitivity 50-80%
| > Specificity 70-80%
126
Anti-CCP antibodies
Better diagnostic marker for RA compared to RF
> Sensitivity 60-70%
> Specificity 90-99%
127
Complications of RA
1) Increased cardiovascular risk
2) Osteopenia (reduced bone mass of lesser severity than osteoporosis)
3) osteoporosis
128
DMARDs side effects
* Bone marrow suppression
* Infection
* Liver function derangement
* Pneumonitis
* Nausea
129
Anti TNF agents
Infliximab, Etanercept, Adalimumab, Certolizumab, Golimumab
130
Anti TNF agents adverse effects
* Risk of infection (esp TB)
* Question over risk of malignancy (esp skin cancer)
* Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
131
Osteophytes
A bony outgrowth associated with the degeneration of cartilage at joints
132
OA X-ray changes
* Marginal osteophytes.
* Joint space narrowing.
* Subchondral sclerosis.
* Subchondral cysts.
133
Increased urate production
o Inherited enzyme defects
o Myeloproliferative/Lymphoproliferative disorders
o Psoriasis
o Haemolytic disorders
o Alcohol (beer, spirits)
o High dietary purine intake (red meat, seafood, corn syrup)
134
Reduced urate excretion
* Chronic renal impairment
* Volume depletion e.g. heart failure
* Hypothyroidism
* Diuretics
* Cytotoxics e.g. cyclosporin
135
Milwaukee shoulder
Hydroxyapatite crystal deposition in or around the joint.
Release of collagenases, serine proteinases and IL-1
> Acute and rapid deterioration.
> Females, 50-60 years
136
Soft tissue rheumatism
General term to describe pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than either the bone or cartilage
Pain should be confined to a specific site e.g. shoulder, wrist etc.
137
Spondyloarthropathies
Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed (HLA B27 positive) individuals
138
Enthesitis
Inflammation at insertion of tendons into bones
139
Red flag signs in back pain
```
Age <20 or >50
Thoracic pain – aortic aneurysm
Previous carcinoma (breast, bronchus, prostate)
Immunocompromise (steroids, HIV)
Feeling unwell
Weight loss
Widespread neurological symptoms
Structural spinal deformity
```
140
Technetium scan
Is a bone scan to show tumours, infection bleeding, using technetium (radioactive substance) as a tracer.
141
Xrays
X-ray – shows dense tissues.
| Dense materials, such as bone and metal, show up as white on X-rays.
142
MRI scan
MRI is a medical imaging modality that creates detailed images of soft tissues.
143
Cellulitis
Cellulitis is a bacterial infection of the deeper layers of skin and the underlying tissue.
Best guess antibiotics to cover Staph and Strep - Flucloxacillin and benzylpenicillin.
144
Blount disease
Blount disease is a growth disorder of the shin bone characterized by inward turning of the lower leg (bowing) that slowly worsens over time.
Growth arrest of medial tibial physis of unknown aetiology (weight overload)
typical Beak-like protrusion on x-ray
145
Knee dislocation
Serious high energy injury with high incidence
Popliteal artery injury
Common peroneal nerve injury
Compartment syndrome
Emergency reduction, recheck neurovascular status.
146
Patellar dislocation
Rapid turn or direct blow
| Increased incidence in females, adolescents, ligamentous laxity, valgus knee, torsional abnormalities
147
Extensor mechanism rupture - mechanism of injury
Fall onto flexed knee with quads contraction 🡪 rupture quads or patellar tendon.
148
Hyaline cartilage
Covers the surface of bone in synovial joints.
Decreases friction and distributes load.
Comprised of water, collagen, proteoglycans & chondrocytes.
149
Chondrocytes
Produce and regulate the extracellular matrix in joints
| No blood vessels - nutrition from synovial fluid and subchondral bone, healing / repair poor.
150
Most common primary bone sarcoma
Osteosarcoma
151
Second most common malignant sarcoma in young adults
Ewing's sracoma
152
Chondrosarcoma
chondrosarcoma, which remember involves abnormal cartilage forming cells or chondrocytes.
153
Osteoid osteoma
Describes a small benign lesion that usually affects the long bones. It has this characteristic ‘o’ appearance on Xray
154
Most common benign bone tumour
Osteochondroma
155
2nd most common benign bone tumour
Enchondroma
156
Tendon
Attach muscle to bone
157
Fibroblast
The predominant cell in tendons is the fibroblast which are responsible for the production and maintenance of collagen and other proteins which confer the flexibility and tensile strength of tendons.
158
Achilles tendonitis
Achille’s tendon rupture is a common injury and tends to occur after a sudden force such as a forceful push off the foot e.g., while running, jumping etc. It is commoner in patients with Rheumatoid arthritis, those on steroids and patients with tendonitis.
Common, middle aged
159
Achilles tendonitis Diagnosis
USS, MRI
160
What medication is responsible for new onset Achilles tendon disorders; tendinitis and tendon rupture
Ciprofloxacin
161
Thompson’s test
| Simmond's test
Same thing
Examines the integrity of the Achilles tendon by squeezing the calf
If the test is positive, there is no movement of the foot on squeezing the corresponding calf, signifying likely rupture of the Achilles tendon.
162
LOAF
Lumbricals IF and MF
Opponens
Abd Pollicis Brevis
Flexor Pollicis Brevis
All innervated by the median nerve
163
Filled with synovial fluid and Fluctuates / trans-illuminates
Ganglion
164
A subungual hematoma
A subungual hematoma is a collection of blood under your fingernail or toenail.
165
Bursitis
Inflammation of the synovium lined sacs that protect bony prominences and joints.
Can become secondarily infected and form an abscess. Bursi are between bones and tendons (cushions)
166
Bursitis management
NSAIDs / Analgesia
Antibiotics
Incision and drainage
167
Lipoma
Benign neoplastic proliferation of fat
168
Risk factors for Hip fractures
```
Osteoporosis - 3x more common in females
Smoking
Malnutrition
Excess alcohol
Neurological impairment
Impaired vision
Low BMI
```
169
Blood supply to femoral head
Intramedullary artery of shaft of femur
Medial & lateral circumflex branches of profunda femoris
Artery of ligamentum teres
170
What are the 2 categories of hip fractures?
Intracapsular
| Extracapsular
171
Types of intracapsular hip fractures
Subcapital
Transcervical
Can be undisplaced/displaced
172
Types of extracapsular hip fractures
basicervical
intratrochantric
Reverse oblique
subtrochantric
173
Management of intracapsular high function hip fracture
Displaced - THR
| Undisplaced - CHS
174
Management of intracapsular Low function hip fracture
Hemi-arthroplasty
175
Management of extracapsular intratrochantric hip fracture
DHS screw
176
Management of extracapsular subtrochantric hip fracture
IM nail
177
Classification of ankle fractures
Weber - A, B and C
178
Tibial Plateau Fractures
Refers to a break or crack in the top of the shin bone, at the knee. It involves the cartilage surface of the knee joint. This joint helps supports your body weight, and when it is fractured, it is unable to absorb shock.
High energy injuries in the young, but low energy injuries in older osteoporotic bone
179
ORIF
Open Reduction Internal Fixation
180
Thomas’ Splint
Immobilizes limbs with fractures - e.g femoral shaft fracture
181
Young-Burgess Classification
Classification of pelvic fractures
182
Humeral shift fracture - nerve injury
Radial
183
Proximal Humeral Fractures
Common injury, typically low energy of osteoporotic bone from a fall
Usually surgical neck fracture (rather than anatomical neck)
184
Posterior shoulder dislocation
Fall with shoulder in internal rotation,
Direct blow to anterior shoulder
Humeral head posterior to the glenoid
Usually due to seizures/electrical shocks
185
Inferior shoulder dislocation
Arm held in abduction.
Humeral head inferior to the glenoid
Needs prompt neurovascular assessment and reduction.
186
Different parts of a bone in children
Epiphysis
Physis
Metaphysis
Diaphysis
187
Greenstick fracture
A greenstick, buckle or torus fracture is a fracture in a young, soft bone in which the bone bends and partially breaks. A person's bones become harder (calcified) and more brittle with age. Greenstick fractures usually occur most often during infancy and childhood when one's bones are soft. The name is by analogy with green wood which similarly breaks on the outside when bent.
188
Salter Harris fracture classification
Salter Harris fracture classification of displaced growth plate fractures
189
Diaphysis
shaft of bone
190
Physis
Growth plate
191
Epiphysis
The end part of a long bone, initially growing separately from the shaft.
192
Metaphysis
The metaphysis is located between the diaphysis and epiphysis.
193
Type I salter harris fracture
A complete physeal fracture with or without displacement
194
Type II salter harris fracture
A physeal fracture that extends through the metaphysis producing a chip fracture o the metaphysis (may be very small)
195
Type III salter harris fracture
A physeal fracture that extends through the epiphysis
196
Type IV salter harris fracture
A physeal fracture that extends through the metaphysis and epiphysis
197
Type V salter harris fracture
A compression fracture of the growth plate
198
Weber A fracture
below the level of the syndesmosis (infrasyndesmotic)
usually transverse
tibiofibular syndesmosis intact
199
Weber B fracture
Distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance
tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint
200
Weber C fracture
above the level of the syndesmosis (suprasyndesmotic)
| tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation
