E2274. Growing Pain! Detecting Pediatric Growth Plate Fractures in the ED
  1. Joseph Joshua; Henry Ford Hospital
  2. Fadi Aboona; Central Michigan University College of Medicine
  3. Jessica Leschied; Henry Ford Hospital
  4. Ingrid Ichesko; Mott Children's Hospital
Musculoskeletal trauma accounts for the majority of pediatric emergency department (ED) visits. Physeal injury is seen in 15% to 30% of all pediatric skeletal injuries and these injuries can have serious consequences if not accurately diagnosed and managed appropriately. Plain radiographs are the primary imaging modality used to assess physeal-related fractures in the ED with imaging findings often subtle or challenging to the non-pediatric trained radiologist.

Educational Goals / Teaching Points
Normal physeal anatomy, and physiology of endochondral ossification. Salter-Harris classification of growth plate fracture with imaging examples. Radiographic appearance of unique pediatric fractures that involve the growth plate and consequences for management. Potential complications of growth plate fractures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Special attention will be paid to: Unique elbow, wrist and ankle fractures Slipped capital femoral epiphysis Apophyseal avulsion fractures Patellar sleeve fracture Chronic growth plate injury Radiographs with correlative magnetic resonance imaging and/or computed tomography, when available will be utilized.

Musculoskeletal trauma accounts for the majority of pediatric ED visits. Accurately diagnosing fractures involving the physis is critical as it can significantly affect patient management and outcome. The practicing emergency radiologist should have a high sensitivity for detecting growth plate fractures. We discussed the normal physeal anatomy and physiology, reviewed several cases that illustrated physeal fractures as well as management and potential complications.