Salter-Harris fractures

Background

• If physis fx missed may lead to premature closure and bone growth arrest
• Ligaments stronger than bones in kids - more likely to fx than sprain
• Repetitive stress injury may also lead to fx
  • Suspect if point tenderness over physis and neg x-ray

Classification

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

Mnemonic

• 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