SALTER-HARRIS FRACTURE

Alex Duckworth, MS4

What is a Salter-Harris fracture?

Fracture through growth plate in a pediatric patient 35 % of skeletal injuries in patients aged 10-15 involve growth plate Often due to trauma, usually sports-related or fall Complain of point tenderness around fracture site Soft-tissue swelling on physical exam

Anatomy of Long Bones

Epiphysis distal to the physis (growth plate) Metaphysis on opposite side of physis from epiphysis Diaphysis is long shaft beyond metaphysis

Normal Pediatric Long Bone

eMedicine Salter-Harris Fractures : Article by William Moore, MD

Bone Growth
Cartilage growth from epiphysis towards metaphysis Neovascularization and primary bone formation occurs from metaphysis towards epiphysis, immature bone remodeled Physis closes when vascular supplies of metaphysis and epiphysis touch Disruption of vasculature can cause growth deformities Classification of fractures impacts treatment options and prognosis/complications

Overview of Classification

Adapted from Disorders and Injuries of the Musculoskeletal System, 3rd Edition. Robert B. Salter, Baltimore, Williams and Wilkins, 1999.

Salter-Harris Type I (5%)

Transverse fracture through physis Width of physis increased Most critical part of growth plate usually remains attached to epiphysis Normally just casting while fracture heals Good prognosis for normal growth

Salter-Harris Type I

eMedicine Salter-Harris Fractures : Article by William Moore, MD http://radiology.creighton.edu/.../case6/index.htm

Salter-Harris Type I

http://members.aol.com/PTdoctor/ salter-harris.html

http://members.fortunecity.com/rad rep/id36.htm

Salter-Harris Type II (75%)

Most common Fracture through physis as well as metaphysis No epiphyseal involvement Usually requires manipulation of fracture back into position and immobilization for normal growth

Salter-Harris Type II

eMedicine Salter-Harris Fractures : Article by William Moore, MD

www.mevis.de/~hhj/TraumaRad/TraumaRa dHiRes.htm

Salter-Harris Type II

eMedicine Salter-Harris Fractures : Article by William Moore, MD

www.uth.tmc.edu/radiology/test/er _primer/shoulder/sh29.html

Salter-Harris Type III (10%)

Fracture involving physis and epiphysis Usually causes damage to reproductive part of physis Chronic disability because of involvement of articular surface Commonly requires surgery Good prognosis for normal growth if blood supply not disrupted to epiphysis and fracture non-displaced

Salter-Harris Type III

eMedicine Salter-Harris Fractures : Article by William Moore, MD

http://www.hawaii.edu/medicine/pediat rics/pemxray/v1c18.html

Salter-Harris Type III

http://members.fortunecity.com/radrep/id36.htm

Salter-Harris Type IV (10%)

Fracture through epiphysis, physis, and metaphysis Also chronic disability because of articular surface involvement Damage to growing cartilage can cause premature fusion of bone Surgery required to realign growth plate Poor prognosis, high risk of growth disturbance

Salter-Harris Type IV

eMedicine Salter-Harris Fractures : Article by William Moore, MD

http://xray.20m.com/photo4.html

Salter-Harris Type IV

http://members.fortunecity.com/radrep/id36.htm

Salter-Harris Type V (<1%)

Rare Typical history of axial load Crush injury of growth plate, no damage to epiphysis or metaphysis Poor prognosis, almost inevitable growth disturbance Diagnosis difficult, often made after premature closure of growth plate seen

Salter-Harris Type V

eMedicine Salter-Harris Fractures : Article by William Moore, MD http://www.hawaii.edu/medicine/pedi atrics/pemxray/v1c18.html

Salter-Harris Type V

http://members.fortunecity.com/radrep/id36.htm

Sources
http://www.hawaii.edu/medicine/pediatrics/pemxray/v1c18.html Radiology Cases in Pediatric Emergency Medicine Volume 1, Case 18 Loren G. Yamamoto, MD, MPH Stanley M.K. Chung, MD Alson S. Inaba, MD Kapiolani Medical Center For Women And Children University of Hawaii John A. Burns School of Medicine http://orthopedics.about.com/cs/generalinfo4/a/salterharris.htm Salter-Harris Fracture Classification Jonathan Cluett, MD eMedicine Salter-Harris Fractures : Article by William Moore, MD