Salter-Harris fractures: Difference between revisions

(Text replacement - "w/o" to "with out")
(Text replacement - "fx" to "fracture")
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*If physis fracture missed may lead to premature closure and bone growth arrest
*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
*Ligaments stronger than bones in kids - more likely to fracture than sprain
*Repetitive stress injury may also lead to fx
*Repetitive stress injury may also lead to fracture
**Suspect if point tenderness over physis and neg x-ray
**Suspect if point tenderness over physis and neg x-ray


===Mnemonic===
===Mnemonic===
*S 1 - Slipped (thru epiphysis)
*S 1 - Slipped (thru epiphysis)
*A 2 - Above (epiphysis c metaphysis fx)
*A 2 - Above (epiphysis c metaphysis fracture)
*L 3 - Lower (thru epiphysis)
*L 3 - Lower (thru epiphysis)
*T 4 - Through (epi and meta)
*T 4 - Through (epi and meta)
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===Type 2 (Above)===
===Type 2 (Above)===
*Most common type of fx
*Most common type of fracture
*fracture through physis and out through piece of metaphyseal bone
*fracture through physis and out through piece of metaphyseal bone
**Growing cells remain on the epiphysis in continuity w/ blood supply
**Growing cells remain on the epiphysis in continuity w/ blood supply
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===Type 3 (Below)===
===Type 3 (Below)===
*Intra-articular fx
*Intra-articular fracture
**fracture extends from epiphysis through physis
**fracture extends from epiphysis through physis
*X-ray shows epiphyseal fragment not a/w metaphyseal fracture
*X-ray shows epiphyseal fragment not a/w metaphyseal fracture
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===Type 5 (Crush)===
===Type 5 (Crush)===
*Physis compression fx
*Physis compression fracture
**Typically occurs at knee or ankle
**Typically occurs at knee or ankle
*May confuse for Type 1 injury
*May confuse for Type 1 injury
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*Types 1-2 - Splint, ortho f/u
*Types 1-2 - Splint, ortho f/u
**Type 1 - may result in disrupted bone growth; may need IF
**Type 1 - may result in disrupted bone growth; may need IF
**Type 2 - most common type of growth plate fx, but generally heal well; may need IF
**Type 2 - most common type of growth plate fracture, but generally heal well; may need IF
*Types 3-4 - Splint, ortho consult
*Types 3-4 - Splint, ortho consult
**Type 3 - more common in older children; requires IF to ensure proper alignment of growth plate and joint surface
**Type 3 - more common in older children; requires IF to ensure proper alignment of growth plate and joint surface

Revision as of 05:37, 9 July 2016

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 c metaphysis fracture)
  • L 3 - Lower (thru epiphysis)
  • T 4 - Through (epi and meta)
  • R 5 - Rammed (growth plate crushed)

Diagnosis

Salter Harris Types

Type 1 (Slip)

  • fracture 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)

  • Most common type of fracture
  • fracture through physis and out through piece of metaphyseal bone
    • Growing cells remain on the epiphysis in continuity w/ 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 a/w metaphyseal fracture
  • Greater the displacement greater chance of vasc supply compromise

Type 4 (Both)

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

  • Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis

Type 5 (Crush)

  • 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

  • Types 1-2 - Splint, ortho f/u
    • Type 1 - may result in disrupted bone growth; may need IF
    • Type 2 - most common type of growth plate fracture, but generally heal well; may need IF
  • Types 3-4 - Splint, ortho consult
    • Type 3 - more common in older children; requires IF to ensure proper alignment of growth plate and joint surface
    • Type 4 - commonly stop bone growth; require IF
  • Type 5 - Casting, NWB, ortho consult / f/u
    • Almost always growth disturbance
    • Cast immobilization or surgery

See Also

References


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