- Radiographic Evaluation:
-
SH Type I:
- physeal frx about knee are more common than lig. injuries in children;
-
stress-views & circumferential physeal tenderness help to make the diagnosis;
-
SH Type II:
- most common frx pattern of distal femoral physis;
- growth arrest, partial or complete, w/ progressive angulation &/or shortening ranges from 30% & 80% of pts;
- look for oblique frx across one corner of adjacent metaphysis;
- displacement is usually in coronal plane w/ metaphyseal frag on side toward which the epiphysis is displaced;
- anatomic reduction can usually be obtained by closed means and maintained by percutaneous crossed K wires &
spica cast
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SH III:
- look for vertical fracture line originating from intercondylar notch;
- reduction may be unstable and require internal fixation;
-
SH IV:
- frx line extending from the articular surface of the epiphysis upward across physis & out
thru metaphysis reflecting SH IV injury;
- x-rays should be inspected carefully Thurston Holland sign
- even small metaphyseal fx indicates SH IV, rather than SH III
-
SH V:
- decreased in nl width of radiolucent physis (which measures 3-5 mm until 8-10 yrs may indicate
a SH type-V compression injury;
