• plantarflexion force displaces the tibial epiphysis posteriorly (SH I or II) • Thurston-Holland fragment is composed of the posterior tibial metaphysis and displaces posteriorly • occurs without fibular fracture • can be difficult to see on AP radiograph
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A 12-year-old male patient sustained a Salter-Harris IV fracture of the distal tibia. He presents 2 years later with the MRI scan images seen in Figures A through C. The distal tibia is in 30 degrees of varus (Figure A). The physeal map is shown in Figure C. What is the best treatment plan?
Physeal bridge resection and fat interposition through a metaphyseal window
Corrective osteotomy, with physeal bridge resection and fat interposition through the osteotomy site
Transarticular arthroscopically-assisted physeal bridge resection and fat interposition through the ankle joint
Completion of epiphysiodesis
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A 12-year-old sustains an ankle injury while running on wet grass. Radiographs are shown in Figures A and B. A reduction maneuver is attempted under conscious sedation but fluoroscopic images are unchanged. What is the next best step in management?
Admit for observation
Cast immobilization and outpatient follow up in 4-6 weeks
Closed reduction under general anesthesia followed by cast immobilization
Open reduction and internal fixation
Repeat closed reduction under general anesthesia & internal fixation followed by cast immobilization
A 12-year-old boy with an ankle fracture undergoes closed reduction under sedation in the emergency department. Figure 27 shows a lateral radiograph of the ankle after two attempts at closed reduction. Based on these findings, treatment should now consist of
at least two more attempts at closed reduction in the emergency department before the patient’s sedation wears off.
at least two attempts at closed reduction in the operating room under general anesthesia with muscle relaxation.
acceptance of the reduction because the alignment is satisfactory and growth problems are rare with Salter-Harris type I fractures.
open reduction, extraction of any interposed periosteum, and smooth wire fixation to prevent nonunion.
open reduction, extraction of any interposed periosteum, and smooth wire fixation to decrease the chance of premature physeal closure.