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Epiphyseal Injuries, Emergency Medicine

Neha P. Raukar and Daniel L. Savitt Reviewed 06/2017



  • Fractures through the physis accounts for 21–30% of pediatric long bone fractures with 30% of these leading to a growth disturbance:

    • Most frequently seen in the distal radius and ulna...


Signs and Symptoms


  • Most commonly occurs after a fall

  • Extreme cold and radiation can injure the physeal plate.

Physical Exam

  • Focal tenderness

  • Swelling

  • Limited mobility

  • If lower extremity invo...



  • Immobilize limb in position found if no compromise in vascular status

  • Apply ice or cold packs to injury.

  • Assess injured extremity for neurologic and vascular function.

  • Consider conc...



Admission Criteria

  • Open fractures

  • Open surgical reduction required

  • Consider with Type III and IV fractures

Discharge Criteria

  • Low-grade fractures and fractures with higher grade if fol...

Pearls and Pitfalls

  • Long-term complications:

    • Limb length discrepancy if entire growth plate affected

    • Angulation if only a part of the physis is affected

  • In patients with suspected SH fracture and negativ...

Additional Reading

  • Rathjen KE, Birch JG. Physeal injuries andgrowth disturbances. In: Beaty JH,Kasser  JR,eds. Rockwood & Wilkins’Fractures in Children. 6th ed. Philadelphia, PA: Lippincott Willi...



  • 812.09 Other closed fracture of upper end of humerus

  • 813.42 Other closed fractures of distal end of radius (alone)

  • 813.43 Closed fracture of distal end of ulna (alone)

  • 824.8 Unspecified fractur...

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