PHYSEALINJURY.ppt

PHYSEAL INJURY 2005?? ??????? ???? ????? ?? ??? ? ?? 2005? 11? 12? ANATOMY VASCULAR SUPPLY Epiphyseal a.: Supplies proliferative zone chondrocytes Nutrient a. Capillary loops ends at the bone-cartilage interface of the growth plate Avascular lower proliferative and hyprtrophic zone ANATOMY VASCULAR SUPPLY Metaphyseal a. and periosteal a. Collateral supply Perichondral a. Supplies perichondral ring of LaCroix ANATOMY Cartilagenous Component Reserve Zone Proliferative Zone Hypertrophic Zone ANATOMY Cartilagenous Component Reserve Zone Chondrocytes produce cartilagenous matrix. Inactive in cell or matrix turnover Low oxygen tension lowest calcium content Not participate in longtitudinal growth ANATOMY Cartilagenous Component Proliferative Zone Highest oxygen tension Matrix production and cellular division contribute to longitudinal growth ANATOMY Cartilagenous Component Hypertrophic Zone Weakest region within the growth plate(low matrix volume, high cellular volume) Ultimate fate of the hypertrophic zone cell is cell death Avascular and low oxygen tension Zone of provisional calcification Cause of Physeal Injury Fracture, disuse, radiation, infection, tumor, vascular impairment, neural involvement, metabolic abnormality, frostbite, burns, electric burns, laser injuries, chronic stress, iatrogenic injury PHYSEAL FRACTURES History Fables of Amazon Hippocrates Severinus(1632) Malgaigne(1855) Poland(1898) FRCTURE PLANE -Between calcified and uncalcified cartilage -Proliferating cells remain with epiphysis. -The plane is avascular, less bleeding and swelling Classification Poland’s Classification(1898): Classification Bergenfeldt(1933): First radiologic classification Classification Aitken(1936) Classification Peterson(1994): Classifcation Salter and Harris(1963): Rang(1969): Classification Salter-Harris Classification Practical, easy to use Guide to rational treatment Covers most fractures Classification Salter-Harris I: Complete separation of ep