![]() ![]() If wrist imaging shows an isolated distal ulnar physeal fracture, further evaluation of the proximal radius should be obtained to rule out associated radial fracture or dislocation, as isolated ulnar physeal fractures are uncommon. ![]() Salter-Harris type II–V fractures are usually apparent on plain radiographs.įorearm physeal fractures in children can have an associated supracondylar fracture, so the lateral forearm view should include the distal humerus or there should be accompanying elbow views. These patients will require outpatient follow-up radiographs at 7 to 10 days, especially if they are still having pain, to assess for signs of bone healing response or other evidence of fracture that may not have been apparent on the original imaging studies. Patients who continue to report tenderness over the growth plate on examination should be treated as if they have a Salter-Harris type I fracture with splinting of the extremity even in the setting of normal radiographs. Nondisplaced Salter-Harris type I fractures will sometimes present with normal radiographs or have only subtle findings such as growth plate widening or surrounding soft-tissue swelling. There are cases in which a fracture may not be evident immediately on plain radiography. ![]() Appropriate pain management is important in patients with potential fractures to help optimize positioning, making interpretation of the imaging study easier. Images should be obtained in at least two planes. Plain radiographs are the standard imaging modality for physeal fractures. There is no shoulder or elbow pain, swelling, or deformity. Capillary refill in his fingers is normal. He has 2+ radial pulses with full range of motion and intact sensation in the radial, ulnar, and median distributions. Physical examination is significant for mild swelling with tenderness to palpation over the distal right forearm. The patient reports that he fell on his outstretched right hand while skateboarding. A 15-year-old male presents to the emergency department with right wrist pain. ![]()
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