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- 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/ http://members.fortunecity.com/rad
salter-harris.html 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 www.mevis.de/~hhj/TraumaRad/TraumaRa
Fractures : Article by William dHiRes.htm
Moore, MD
- Salter-Harris Type II
eMedicine – Salter-Harris Fractures : www.uth.tmc.edu/radiology/test/er
Article by William Moore, MD _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 : http://www.hawaii.edu/medicine/pediat
Article by William Moore, MD 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 http://xray.20m.com/photo4.html
Moore, MD
- Salter-Harris Type IV
http://members.fortunecity.com/radrep/id36.htm
- Salter-Harris Type V (
- Salter-Harris Type V
eMedicine – Salter-Harris Fractures :
Article by William Moore, MD
http://www.hawaii.edu/medicine/pedi
atrics/pemxray/v1c18.html
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