Case 2 J.B. is a 13-year old boy who fractured his right arm in a snowboarding accident. An X-ray of the arm reveals a distal fracture that extends through the epiphyseal plate. J.B. has had no previous medical conditions and is otherwise healthy. His fracture requires placement of a surgical pin to reattach the distal bone fragment. After the surgery, the extremity is casted.

1. Of what significance is the involvement of the epiphyseal plate in the fracture line?

2. The surgical pin procedure increases the risk for bone infection. How would bone infection be manifested?

3. In the early post-operative period, the extremity may swell within the cast, leading to compression of blood supply and compartment syndrome. How would compartment syndrome manifest and what should be done if it occurs?

The hyaline cartilage at the end of the metaphysis of every long bone is referred to as the Epiphyseal plate. This plate is responsible for growth in every bone. Thus if the integrity of the epiphyseal plate is not preserved during the surgery, there will be impaired growth of the bone, giving rise to the shortening of that particular limb.

2. The first symptom of bone infection first is generalized fever, pain in the area, followed by swelling, and if not intervened, abscess, and sinus formation may occur.

3. The symptoms of compartment syndrome include extreme severe pain, decreased sensation in the distal end of the limb, absent distal pulsation, and restriction of distal joint movements.

The treatment for compart syndrome is the fasciotomy of the involved compartments of the limbs.