Physeal injuries in children

The paediatric skeleton differs from that of an adult in that the bones are more elastic and they contain growth plates (physes). Physeal injuries affect the growth plates of children and adolescents. A basic understanding of the anatomy and physiology of the physis is mandatory in order that injuries to the growth plate can be managed effectively. Salter and Harris described a classification for physeal injuries based on radiographic findings. The system predicts the prognosis for any given injury and guides treatment choice. The goal of treatment is to achieve and maintain an acceptable reduction of the fracture without compromising the germinal layer of the growth plate. A comprehensive understanding of remodelling potential related to patient age and site of injury is essential and influences treatment. Occasionally, malunion and growth arrest can occur. The management of these complications ranges from simple observation to complex deformity correction. The clinician should know how to avoid such complications but also know how to recognize them should they occur.