Diagnosis

21r-E/2 Radius, epiphysiolysis with metaphyseal wedge, Salter-Harris II

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The majority of fractures of the proximal radius in childhood are radial neck fractures, 21r-E and 21r-M.

Isolated epiphyseal fractures of the radius with a separation of epi- and metaphysis including a metaphyseal wedge attached to the epiphyseal fragment (Salter-Harris II) are classified as 21r-E/2.

An additional code (I-III) takes into account the axial deviation and level of displacement.

Options
1. 21r-E/2.1 I Epiphysiolysis with metaphyseal wedge, SH II, no angulation and no displacement
2. 21r-E/2 II Epiphysiolysis with metaphyseal wedge, SH II, angulation with displacement of up to half of the bone diameter
3. 21r-E/2 III Epiphysiolysis with metaphyseal wedge, SH II, angulation with displacement of more than half of the bone diameter

1. 21r-E/2.1 I Epiphysiolysis with metaphyseal wedge, SH II, no angulation and no displacement

21r-E/2.1 I

21r-E/2.1 I

Type-I fractures are undisplaced without angulation.

2. 21r-E/2 II Epiphysiolysis with metaphyseal wedge, SH II, angulation with displacement of up to half of the bone diameter

21r-E/2 II

21r-E/2 II

Type-II fractures are fractures with angulation and displacement of up to half of the bone diameter. Displacement is usually lateral. The metaphyseal wedge is usually on the same side as the displacement.

The annular ligament is intact but may be trapped between the fracture fragments.

The head may be impacted in the metaphysis.

3. 21r-E/2 III Epiphysiolysis with metaphyseal wedge, SH II, angulation with displacement of more than half of the bone diameter

21r-E/2 III

21r-E/2 III

Medial displacement

Medial displacement

Type-III fractures are angulated fractures with displacement of more than half of the bone diameter. Displacement is usually lateral. The metaphyseal wedge is usually on the same side as the displacement.

The annular ligament is intact but may be trapped between the fracture fragments.

The head may be impacted in the metaphysis.

Medial displacement
This fracture pattern is very rare.

The radial head may be completely displaced medially.

This type of fracture has the highest risk of AVN because of circumferencial disruption of the periosteum.

Take care that the surgical approach does not complete disruption of the periosteum.

AP and lateral view of a dorsal displacement of the radial head (arrow)

AP and lateral view of a dorsal displacement of the radial head (arrow)