Salter-Harris fractures
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 with metaphysis fracture)
- L 3 - Lower (thru epiphysis)
- T 4 - Through (epinephrine and meta)
- R 5 - Rammed (growth plate crushed)
Clinical Features
- Trauma with point tenderness over a physis
Differential Diagnosis
Evaluation
Type 1 (Slip)
- fracture through hypertrophic zone of physis (epiphysis separates from metaphysis)
- Growing cells remain on the epiphysis in continuity with blood supply
- Good prognosis
- Growing cells remain on the epiphysis in continuity with blood supply
- 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 with 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 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)
- 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 follow up
- 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 / follow up
- Almost always growth disturbance
- Cast immobilization or surgery
Disposition
See Also
References
- POSNA (Pediatric Orthopaedic Society of North America) - http://orthoinfo.aaos.org/topic.cfm?topic=A00040