Salter-Harris fractures: Difference between revisions
Line 65: Line 65:


===Type II===
===Type II===
*Removable ankle brace<ref>. Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, Schuh S. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007;119(6): e1256-e1263.</ref>
*Most: Splint, ortho follow up
*Ortho follow up
*Ankle: Removable ankle brace<ref>. Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, Schuh S. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007;119(6): e1256-e1263.</ref>


===Type III-V===
===Type III-V===

Revision as of 17:46, 17 February 2017

Background

  • The higher the classification, the higher the likelihood of growth abnormalities
  • If physis fracture missed may lead to premature closure and bone growth arrest
  • Ligaments stronger than bones in kids - more likely to fracture than sprain
  • Repetitive stress injury may also lead to fracture
    • Suspect if point tenderness over physis and neg x-ray

Mnemonic

  • S 1 - Slipped (thru epiphysis)
  • A 2 - Above (epiphysis with metaphysis fracture)
  • L 3 - Lower (thru epiphysis)
  • T 4 - Through (epinephrine and meta)
  • R 5 - Rammed (growth plate crushed)

Clinical Features

  • Trauma with point tenderness over a non-closed (pediatric) physis

Differential Diagnosis

  • Sprain
  • Contusion
  • Other fracture

Evaluation

Salter Harris Types

Type 1 (Slip)

  • fracture through hypertrophic zone of physis (epiphysis separates from metaphysis)
    • Growing cells remain on the epiphysis in continuity with blood supply
      • Good prognosis
  • Occurs mostly in infants and todlers
  • Suspect if point tenderness over a physis
  • X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)

Type 2 (Above)

  • Most common type of fracture
  • fracture through physis and out through piece of metaphyseal bone
    • Growing cells remain on the epiphysis in continuity with blood supply
    • Good prognosis
  • X-ray shows triangular fragment of metaphysis with out injury to epiphysis

Type 3 (Below)

  • Intra-articular fracture
    • fracture extends from epiphysis through physis
  • X-ray shows epiphyseal fragment not associated with etaphyseal fracture
  • Greater the displacement greater chance of vascular supply compromise

Type 4 (Both)

  • fracture starts at articular surface and extends through epiphysis, physis, metaphysics

Type 5 (Crush)

Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis
  • Physis compression fracture
    • Typically occurs at knee or ankle
  • May confuse for Type 1 injury
    • X-ray findings may be minimal
  • Highest chance of growth arrest
  • Suspect based on mechanism of injury, joint effusion

Management

Type I

  • Most: Splint, ortho follow up
  • lateral ankle:
    • Removable ankle brace
    • Return to activities as tolerated by pain
    • No ortho followup

Type II

  • Most: Splint, ortho follow up
  • Ankle: Removable ankle brace[1]

Type III-V

  • Splint, ortho consult

Disposition

  • Outpatient

See Also

References

  1. ↑ . Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, Schuh S. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007;119(6): e1256-e1263.
Retrieved from "https://www.wikem.org/w/index.php?title=Salter-Harris_fractures&oldid=123384"