Uncommon injury in a school punished child

摘要

Epiphyseal injuries are common in children predominantly of the small joints of hand and wrist. They account for nearly 17.9 percent of all paediatric fractures. Of which, 15 percent result into growth arrest. The junction between the metaphysis and epiphysis being the weakest point of a long bone in children makes it more vulnerable to shearing forces. We report this case because of its unusual mode of injury and to highlight the methods of punishment in school leading to injury, which sometimes goes unnoticed but may have serious sequale. Case History A 10 years old right-handed female child came to the Accident and Emergency department accompanied by her school teacher. On examination, the dorsum of her right hand, second web space, index and middle fingers were swollen, bruised and tender and in position of extension at metacarpophalangeal and flexion at interphalangeal joints.She gave a history of fall while playing. Radiographic examination revealed Type II Salter Harris growth plate injuries (Fig 1 and 2) of proximal phalanx of index and middle fingers.