Salter-Harris fractures: Difference between revisions

Revision as of 23:29, 26 June 2011

Background

If physis fx missed > premature closure and bone growth arrest
Most common after age 10
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 x-ray

Types

Type 1 (Slip)

Fx through hypertrophic zone of physis (epiphysis separates from metaphysis)
- Growing cells remain on the epiphysis in continuity w/ 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)

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

Type 3 (Below)

Intra-articular fx
- Fx extends from epiphysis through physis
X-ray shows epiphyseal fragment not a/w metaphyseal fracture
Greater the displacement greater chance of vasc supply compromise

Type 4 (Both)

Fx starts at articular surface and extends through epiphysis, physis, metaphysis

Type 5 (Crush)

Physis compression fx
- Typically occurs at knee or ankle
May confuse for Type 1 injury
Highest chance of growth arrest
X-ray findings may be minimal
Suspect based on mechanism of injury, joint effusion

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)

Treatment

Types 1 2 - Splint, ortho f/u
Types 3-4- Splint, ortho consult
Type 5 - Casting, NWB, ortho consult / f/u

Authors:

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 ==Background==
-* is composed of proliferating cartilage cells and lacks inherent strength and therfore easily damaged.
+*If physis fx missed > premature closure and bone growth arrest
-* injury can happen at any age but most common during period of rapid growth
+*Most common after age 10
-* if missed- prematume closure and bone growth arrest
+*Distal radius most common site
-* most common after age 10
+*Ligaments stronger than bones in kids - more likely to fx than sprain
-* more in boys- more active and later skeletal maturity than girls
+*Repetitive stress injury can also cause it
-* funtion of physis is for rapid longitudinal bone growth
+**Suspect if point tenderness over physis and neg x-ray
-* 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
+*Fx through hypertrophic zone of physis (epiphysis separates from metaphysis)
-* mostly in infants and todlers
+**Growing cells remain on the epiphysis in continuity w/ blood supply
-* by shearing torsion avulsion
+***Good prognosis
-* fx thru hypertrophic zone with growing cells remaining on the epiphysis in continuity with blood supply
+*Occurs mostly in infants and todlers
-* no osseous fx
+*Suspect if point tenderness over a physis
-* good prognosis
+*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)
 ===Type 2 (Above)===
-* fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis.
+*Fx through physis and out through piece of metaphyseal bone
-* most common type of fx
+*Most common type of fx
-* segment of metaphyseal bone called Thurston Holland fragment
+***Growing cells remain on the epiphysis in continuity w/ blood supply
+***Good prognosis
+*X-ray shows triangular fragment of metaphysis w/o injury to epiphysis
 ===Type 3 (Below)===
-* intraarticular fx
+*Intra-articular fx
-* relatively rare
+**Fx extends from epiphysis through physis
-* the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance
+*X-ray shows epiphyseal fragment not a/w metaphyseal fracture
+*Greater the displacement greater chance of vasc supply compromise
 ===Type 4 (Both)===
-* starts at articular surface thru epiphysis thru physisi thru metaphys
+*Fx starts at articular surface and extends through epiphysis, physis, metaphysis
-* mostly at distal humerus
 ===Type 5 (Crush)===
-* most rare type
+*Physis compression fx
-* highest chance of growth arrest
+**Typically occurs at knee or ankle
-* compression crushes cells of zone of reserve and proliferation
+*May confuse for Type 1 injury
-* minimal or no displacement of epiphysis
+*Highest chance of growth arrest
-* usually at knee or ankle by severe adduction abductn
+*X-ray findings may be minimal
-* usually dx in retrospect once bone growth abnormality already seen
+*Suspect based on mechanism of injury, joint effusion
 ==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
+*Types 1 2 - Splint, ortho f/u
-* type 3-4- surg, probably ORIF
+*Types 3-4- Splint, ortho consult
-* type 5- ortho, casting and nonwt bearing
+*Type 5 - Casting, NWB, ortho consult / f/u
 [[Category:Peds]]
 [[Category:Ortho]]