[Treatment of physeal fractures in children]

The aim of the study was to determine final clinical and radiological results of epiphyseal fractures treated in our hospital. Thirty-five patients were included in the study (6 girls and 29 boys) aged from 5 to 17 years (mean 12.1 years). Follow up ranged from 2 to 20 years. According to Salter and Harris classification system 15 patients had type I and 20 had type II fracture. According to the Neer-Horowitz classification system of the proximal end of humerus one patient had grade III and three had grade IV fracture. Physeal fractures included: proximal end of humerus (n = 4), distal end of radius (n = 16) (with coexistent distal end of ulna fractures in 6 cases), distal end of femur (n = 4), distal end of tibia (n = 3) and distal end fibula (n = 8). Six patients were treated with open reduction and K-wire fixation, three with skeletal traction and cast, one with closed reduction and K-wire fixation and twenty five with closed reduction and cast. Neurovascular deficit was noted in any of our patients at admission and after reduction. During follow-up we did not notice physeal arrest, changes in limbs axis or limb shortening in any of our patients. All our patients had good clinical results. In 2 cases in early postoperative follow-up limitation of shoulder abduction after physeal fracture of proximal humerus was observed. Restoration of proper anatomical conditions is conducive to restore function of growth plate. Kirschner wire fixation did not increase the risk of growth arrest. Physeal injuries at the end of growth did not cause limb axis changes.