Salter-Harris fractures: Difference between revisions
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[[File:Salter_Harris.jpg|thumb|Salter Harris Types]] | [[File:Salter_Harris.jpg|thumb|Salter Harris Types]] | ||
===Type 1 (Slip)=== | ===Type 1 (Slip)=== | ||
*Suspect if point tenderness over a physis | *Suspect if point tenderness over a physis | ||
*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis) | *X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis) | ||
===Type 2 (Above)=== | ===Type 2 (Above)=== | ||
*X-ray shows triangular fragment of metaphysis with out injury to epiphysis | *X-ray shows triangular fragment of metaphysis with out injury to epiphysis | ||
===Type 3 (Below)=== | ===Type 3 (Below)=== | ||
*X-ray shows epiphyseal fragment not associated with etaphyseal fracture | *X-ray shows epiphyseal fragment not associated with etaphyseal fracture | ||
*Greater the displacement greater chance of vascular supply compromise | *Greater the displacement greater chance of vascular supply compromise | ||
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===Type 5 (Crush)=== | ===Type 5 (Crush)=== | ||
[[File: Salter_harris.JPG|thumb|Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis]] | [[File: Salter_harris.JPG|thumb|Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis]] | ||
* | *X-ray shows physis compression fracture | ||
* | **May confuse for Type 1 injury | ||
*May confuse for Type 1 injury | |||
**X-ray findings may be minimal | **X-ray findings may be minimal | ||
==Management== | ==Management== | ||
Revision as of 19:55, 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
- It was previously taught that ligaments are stronger than bones in kids (and fractures were more likely than sprains), however newer studies (to date in ankles) contradict that assumption[1]
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)
Fracture Chart
| Type | I (Slip) | II (Above) | III (Below) | IV (Through) | V (Crush) |
| Fracture Location | hypertrophic zone of physis (epiphysis separates from metaphysis) | Through physis and out through piece of metaphyseal bone | Intra-articular | Starts at articular surface and extends through epiphysis, physis, metaphysics | Physis compression |
| Pathophysiology | Growing cells remain on the epiphysis in continuity with blood supply | Growing cells remain on the epiphysis in continuity with blood supply | fracture extends from epiphysis through physis | ||
| Epidemiology | Occurs mostly in infants and todlers | Most common type of fracture | Typically occurs at knee or ankle | ||
| Prognosis | Good | Good | Moderate | Moderate | Highest chance of growth arrest |
Clinical Features
- Trauma with point tenderness over a non-closed (pediatric) physis
Differential Diagnosis
- Sprain
- Contusion
- Other fracture
Evaluation
Type 1 (Slip)
- Suspect if point tenderness over a physis
- X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)
Type 2 (Above)
- X-ray shows triangular fragment of metaphysis with out injury to epiphysis
Type 3 (Below)
- 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)
- X-ray shows physis compression fracture
- May confuse for Type 1 injury
- X-ray findings may be minimal
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[2]
Type III-V
- Splint, ortho consult
Disposition
- Outpatient
See Also
External Links
- POSNA (Pediatric Orthopaedic Society of North America) - http://orthoinfo.aaos.org/topic.cfm?topic=A00040
References
- ↑ Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012; 94(13):1234-1244.
- ↑ . 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.