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Distal Femoral Physeal Frxs: X-ray Evaluation

- 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
   - 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 through 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