Reachout Orthopedics - Issue 1

SHOULD WE REALLY COMPRESS THE FRACTURE LINE IN THE TREATMENT OF SALTER– HARRIS TYPE 4 DISTAL FEMORAL FRACTURES? A BIOMECHANICAL STUDY Sermet Inal 1 , Kadir Gok 2 (  ), Arif Gok 3 , Alaaddin Oktar Uzumcugil 1 , Sabit Numan Kuyubasi 4 1  Department of Orthopaedic Surgery, School of Medicine, Kutahya Health Sciences University, Campus of Evliya Celebi, 43100 Kutahya, Turkey 2  Department of Mechanical and Manufacturing Engineering, Hasan Ferdi Turgutlu Technology Faculty, Manisa Celal Bayar University, 45400 Manisa, Turkey kadir.gok@cbu.edu.tr 3  Department of Mechanical Engineering, Technology Faculty, Amasya University, 05000 Amasya, Turkey 4 Department of Orthopaedic Surgery, Kutahya Education and Research Hospital, 43100 Kutahya, Turkey In the treatment of intra-articular Salter-Harris (SH) fractures, the aim is to minimize the level of injury in the physeal plate and complete the fracture recovery in a usual way close to perfection. A need always exists for an anatomical reduction with surgical treatment to reduce the poor prognosis of these fractures and prevent possible deformities. Even if an open reduction for SH type 4 fracture is performed almost immediately, no biomechanical evidence is available other than a few studies on how fracture fixation is affected and how it affects the growth of cartilage under load. S alter and Harris (SH) described two main types of physeal plates: pressure epiphysis and traction epiphysis. Pressure epiphyses are found at the end of long bones and provide longitudinal growth. It is intra- articular and weight bearing. In contrast, the traction epiphyses are located in the root or attachment region of the muscles and provide appositional growth. They are extra-articular and do not bear weight [1, 2]. The layers of the pressure physis plate have four regions. The first one is closest to the epiphysis, which contains resting cells and inactive chondroblasts; it is called the “resting zone.” The metaphysial side of this region is the second region with more active chondrocytes producing extracellular matrix proteins; it is called the “proliferative zone.” The third region, the “hypertrophic zone,” is the layer where extracellular matrix proteins are less produced; it includes larger and organized chondrocytes. The hypertrophic layer is divided into sublayers called “maturation, degeneration and provisional calcification regions.” The provisional calcification region has a transition area including calcified and non-calcified extracellular matrix proteins, which makes this area the weakest region. Histologically, SHmentioned that the physeal separation and fracture propagation typically occur in this area [2, 3]. The fourth region is called the “calcification zone” where the cartilage is calcified and the bone is remodeled [3]. In 1963, SH described five types of growth cartilage injury. SH classification helps to 2 Views and Reviews