• Salter Harris I or II
Blow to pubis/ischial ramus/proximal femur leads to injury at interface of 2 superior arms of triradiate cartilage and metaphyses of ilium.
A triangular medial metaphyseal fragment (Thurston-Holland fragment) is often seen in SH II injuries.
• Salter Harris V
Difficult to see on initial radiographs. May detect narrowing of triradiate space. Leads to premature triradiate cartilage closure. The earlier the closure, the greater the eventual deformity.
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A 14-year-old boy presents with right groin pain which occurred during soccer practice. He reports hearing a 'snap' and immediate pain. On physical exam, he has pain over the right hip with resisted knee extension. Radiograph is shown in Figure A. Which muscle origin is at the site of injury?
Long head of the biceps femoris
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A 6-year-old boy is hit by a car while crossing the street. He is intubated at the scene. A radiograph of his pelvis is shown in Figure A. He is hemodynamically stable and has no genitourinary injuries. CT scan of his abdomen and pelvis confirms symphyseal diastasis measuring 1.2cm and right sacroiliac joint diastasis measuring 0.7cm. What is the most appropriate next step in management?
Bed rest followed by progressive mobilization
Bedside reduction using an external fixator
Temporary pelvic binder placement followed by delayed external fixation
Elective anterior symphyseal pinning and posterior sacroiliac screw placement
Elective anterior symphyseal plating and posterior sacroiliac plating