Salter-Harris fractures: Difference between revisions

Revision as of 23:45, 7 June 2011

Background

is composed of proliferating cartilage cells and lacks inherent strength and therfore easily damaged.
injury can happen at any age but most common during period of rapid growth
if missed- prematume closure and bone growth arrest
most common after age 10
more in boys- more active and later skeletal maturity than girls
funtion of physis is for rapid longitudinal bone growth
distal radius most common site
ligaments stronger than bones in kids- more likely to fx than sprain
repetitive stress injury can also cause it
suspect if point tenderness over physis and neg xray

Types

Type 1- slip

slip through epiphysis

mostly in infants and todlers

by shearing torsion avulsion
fx thru hypertrophic zone with growing cells remaining on the epiphysis in continuity with blood supply
no osseous fx
good prognosis

Type 2- above

fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis.
most common type of fx
segment of metaphyseal bone called Thurston Holland fragment

Type 3- below

intraarticular fx
relatively rare
the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance

Type 4- both

starts at articular surface thru epiphysis thru physisi thru metaphys
mostly at distal humerus

Type 5- crush

most rare type
highest chance of growth arrest
compression crushes cells of zone of reserve and proliferation
minimal or no displacement of epiphysis
usually at knee or ankle by severe adduction abductn
usually dx in retrospect once bone growth abnormality already seen

Mneumonic

S 1- Slipped (thru epiphysis)

A 2- Above (epiphysis c metaphysis fx)

L 3- Lower (thru epiphysis)

T 4- Through (epi and meta)

R 5- Rammed (growth plate crushed)

(*reference joint is below*)

Diagnosis

X rays

can have acute fx ang neg x ray- look for point tenderness over physis
type 2-3-4 can see on xray
type 1 - 5 can be occult
type 5 may have effusion
can also use stress radiography

Treatment

type 1 2- splint
type 3-4- surg, probably ORIF
type 5- ortho, casting and nonwt bearing

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+* is composed of proliferating cartilage cells and lacks inherent strength and therfore easily damaged.
+* injury can happen at any age but most common during period of rapid growth
+* if missed- prematume closure and bone growth arrest
+* most common after age 10
+* more in boys- more active and later skeletal maturity than girls
+* funtion of physis is for rapid longitudinal bone growth
+* distal radius most common site
+* ligaments stronger than bones in kids- more likely to fx than sprain
+* repetitive stress injury can also cause it
+* suspect if point tenderness over physis and neg xray
+==Types==
+===Type 1- slip===
+* slip through epiphysis
+ mostly in infants and todlers
+* by shearing torsion avulsion
+* fx thru hypertrophic zone with growing cells remaining on the epiphysis in continuity with blood supply
+* no osseous fx
+* good prognosis
+===Type 2- above===
+* fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis.
+* most common type of fx
+* segment of metaphyseal bone called Thurston Holland fragment
+===Type 3- below===
+* intraarticular fx
+* relatively rare
+* the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance
+===Type 4- both===
+* starts at articular surface thru epiphysis thru physisi thru metaphys
+* mostly at distal humerus
+===Type 5- crush===
+* most rare type
+* highest chance of growth arrest
+* compression crushes cells of zone of reserve and proliferation
+* minimal or no displacement of epiphysis
+* usually at knee or ankle by severe adduction abductn
+* usually dx in retrospect once bone growth abnormality already seen
+==Mneumonic==
 S 1- Slipped (thru epiphysis)
@@ Line 13: / Line 54: @@
 (*reference joint is below*)
-- most significant diff btwn adult and child bones is presenece of physis/ growth plate
-- is composed of proliferating cartilage cells and lacks inherent strength and therfore easily damaged.
-- injury can happen at any age but most common during period of rapid growth
-- if missed- prematume closure and bone growth arrest
-- most common after age 10
-- more in boys- more active and later skeletal maturity than girls
-- funtion of physis is for rapid longitudinal bone growth
-- distal radius most common site
-- ligaments stronger than bones in kids- more likely to fx than sprain
-- repetitive stress injury can also cause it
-- suspect if point tenderness over physis and neg xray
-Physis zones- epiphysis to metaphys. Blood supply from epiphysis
-- resting cells
-- proliferating cells
-- hypertophic/ maturing cells- weakest link were fx occurs
-- zone of provisional calcification
-- higher the salter #, the more physeal arrest and joint incongruity because of injury to vascular supply to physis
-==Types==
-Type 1- slip
-- slip through epiphysis
-- mostly in infants and todlers
-- by shearing torsion avulsion
-- fx thru hypertrophic zone with growing cells remaining on the epiphysis in continuity with blood supply
-- no osseous fx
-- good prognosis
-Type 2- above
-- fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis.
-- most common type of fx
-- segment of metaphyseal bone called Thurston Holland fragment
-Type 3- below
-- intraarticular fx
-- relatively rare
-- the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance
-Type 4- both
-- starts at articular surface thru epiphysis thru physisi thru metaphys
-- mostly at distal humerus
-Type 5- crush
-- most rare type
-- highest chance of growth arrest
-- compression crushes cells of zone of reserve and proliferation
-- minimal or no displacement of epiphysis
-- usually at knee or ankle by severe adduction abductn
-- usually dx in retrospect once bone growth abnormality already seen
 ==Diagnosis==
 X rays
+* can have acute fx ang neg x ray- look for point tenderness over physis
-- can have acute fx ang neg x ray- look for point tenderness over physis
+* type 2-3-4 can see on xray
+* type 1 - 5 can be occult
-- type 2-3-4 can see on xray
+* type 5 may have effusion
+* can also use stress radiography
-- type 1 - 5 can be occult
-- type 5 may have effusion
-- can also use stress radiography
 ==Treatment==
+* type 1 2- splint
+* type 3-4- surg, probably ORIF
-- type 1 2- splint
+* type 5- ortho, casting and nonwt bearing
-- type 3-4- surg, probably ORIF
-- type 5- ortho, casting and nonwt bearing
 [[Category:Peds]]
+[[Category:Ortho]]