SALTER-HARRIS FRACTURE Alex Duckworth, MS4 What is a Salter-Harris fracture? Fracture through growth plate in a pediatric patient 35 % of skeletal injuries in patients aged 10-15 involve growth plate Often due to trauma, usually sports-related or fall Complain of point tenderness around fracture site Soft-tissue swelling on physical exam Anatomy of Long Bones Epiphysis distal to the physis (growth plate) Metaphysis on opposite side of physis from epiphysis Diaphysis is long shaft beyond metaphysis Normal Pediatric Long Bone eMedicine – Salter-Harris Fractures : Article by William Moore, MD Bone Growth Cartilage growth from epiphysis towards metaphysis Neovascularization and primary bone formation occurs from metaphysis towards epiphysis, immature bone remodeled Physis closes when vascular supplies of metaphysis and epiphysis touch Disruption of vasculature can cause growth deformities Classification of fractures impacts treatment options and prognosis/complications Overview of Classification Adapted from Disorders and Injuries of the Musculoskeletal System, 3rd Edition Robert B Salter, Baltimore, Williams and Wilkins, 1999 Salter-Harris Type I (5%) Transverse fracture through physis Width of physis increased Most critical part of growth plate usually remains attached to epiphysis Normally just casting while fracture heals Good prognosis for normal growth Salter-Harris Type I eMedicine – Salter-Harris Fractures : Article by William Moore, MD http://radiology.creighton.edu/ /case6/index.htm Salter-Harris Type I http://members.aol.com/PTdoctor/ salter-harris.html http://members.fortunecity.com/rad rep/id36.htm Salter-Harris Type II (75%) Most common Fracture through physis as well as metaphysis No epiphyseal involvement Usually requires manipulation of fracture back into position and immobilization for normal growth Salter-Harris Type II eMedicine – Salter-Harris Fractures : Article by William Moore, MD www.mevis.de/~hhj/TraumaRad/TraumaRa dHiRes.htm Salter-Harris Type II eMedicine – Salter-Harris Fractures : Article by William Moore, MD www.uth.tmc.edu/radiology/test/er _primer/shoulder/sh29.html Salter-Harris Type III (10%) Fracture involving physis and epiphysis Usually causes damage to reproductive part of physis Chronic disability because of involvement of articular surface Commonly requires surgery Good prognosis for normal growth if blood supply not disrupted to epiphysis and fracture non-displaced Salter-Harris Type III eMedicine – Salter-Harris Fractures : Article by William Moore, MD http://www.hawaii.edu/medicine/pediat rics/pemxray/v1c18.html Salter-Harris Type III http://members.fortunecity.com/radrep/id36.htm Salter-Harris Type IV (10%) Fracture through epiphysis, physis, and metaphysis Also chronic disability because of articular surface involvement Damage to growing cartilage can cause premature fusion of bone Surgery required to realign growth plate Poor prognosis, high risk of growth disturbance Salter-Harris Type IV eMedicine – Salter-Harris Fractures : Article by William Moore, MD http://xray.20m.com/photo4.html Salter-Harris Type IV http://members.fortunecity.com/radrep/id36.htm Salter-Harris Type V (