SALTERSALTER--HARRIS HARRIS FRACTUREFRACTURE

Alex Duckworth, MS4Alex Duckworth, MS4

What is a SalterWhat is a Salter--Harris fracture?Harris fracture?

Fracture through growth plate in a pediatric Fracture through growth plate in a pediatric patientpatient35 % of skeletal injuries in patients aged 1035 % of skeletal injuries in patients aged 10--15 15 involve growth plateinvolve growth plateOften due to trauma, usually sportsOften due to trauma, usually sports--related or related or fallfallComplain of point tenderness around fracture Complain of point tenderness around fracture sitesiteSoftSoft--tissue swelling on physical examtissue swelling on physical exam

Anatomy of Long BonesAnatomy of Long Bones

Epiphysis distal to the Epiphysis distal to the physisphysis (growth (growth plate)plate)

MetaphysisMetaphysis on opposite side of on opposite side of physisphysisfrom epiphysisfrom epiphysis

DiaphysisDiaphysis is long shaft beyond is long shaft beyond metaphysismetaphysis

Normal Pediatric Long BoneNormal Pediatric Long Bone

eMedicine – Salter-Harris Fractures : Article by William Moore, MD

Bone GrowthBone GrowthCartilage growth from epiphysis towards Cartilage growth from epiphysis towards metaphysismetaphysisNeovascularizationNeovascularization and primary bone formation and primary bone formation occurs from occurs from metaphysismetaphysis towards epiphysis, towards epiphysis, immature bone remodeledimmature bone remodeledPhysisPhysis closes when vascular supplies of closes when vascular supplies of metaphysismetaphysis and epiphysis touchand epiphysis touchDisruption of vasculature can cause growth Disruption of vasculature can cause growth deformitiesdeformitiesClassification of fractures impacts treatment Classification of fractures impacts treatment options and prognosis/complicationsoptions and prognosis/complications

Overview of ClassificationOverview of Classification

Adapted from Disorders and Injuries of the Musculoskeletal System, 3rd Edition. Robert B. Salter, Baltimore, Williams and Wilkins, 1999.

SalterSalter--Harris Type I (5%)Harris Type I (5%)

Transverse fracture through Transverse fracture through physisphysisWidth of Width of physisphysis increasedincreasedMost critical part of growth plate usually Most critical part of growth plate usually remains attached to epiphysisremains attached to epiphysisNormally just casting while fracture healsNormally just casting while fracture healsGood prognosis for normal growthGood prognosis for normal growth

SalterSalter--Harris Type IHarris Type I

eMedicine – Salter-Harris Fractures : Article by William Moore, MD

http://radiology.creighton.edu/.../case6/index.htm

SalterSalter--Harris Type IHarris Type I

http://members.aol.com/PTdoctor/salter-harris.html

http://members.fortunecity.com/radrep/id36.htm

SalterSalter--Harris Type II (75%)Harris Type II (75%)

Most commonMost commonFracture through Fracture through physisphysis as well as as well as metaphysismetaphysisNo No epiphysealepiphyseal involvementinvolvementUsually requires manipulation of fracture Usually requires manipulation of fracture back into position and immobilization for back into position and immobilization for normal growthnormal growth

SalterSalter--Harris Type IIHarris Type II

eMedicine – Salter-Harris Fractures : Article by William Moore, MD

www.mevis.de/~hhj/TraumaRad/TraumaRadHiRes.htm

SalterSalter--Harris Type IIHarris Type II

eMedicine – Salter-Harris Fractures : Article by William Moore, MD

www.uth.tmc.edu/radiology/test/er_primer/shoulder/sh29.html

SalterSalter--Harris Type III (10%)Harris Type III (10%)

Fracture involving Fracture involving physisphysis and epiphysisand epiphysisUsually causes damage to reproductive Usually causes damage to reproductive part of part of physisphysisChronic disability because of involvement Chronic disability because of involvement of of articulararticular surfacesurfaceCommonly requires surgeryCommonly requires surgeryGood prognosis for normal growth if blood Good prognosis for normal growth if blood supply not disrupted to epiphysis and supply not disrupted to epiphysis and fracture nonfracture non--displaceddisplaced

SalterSalter--Harris Type IIIHarris Type III

eMedicine – Salter-Harris Fractures : Article by William Moore, MD

http://www.hawaii.edu/medicine/pediatrics/pemxray/v1c18.html

SalterSalter--Harris Type IIIHarris Type III

http://members.fortunecity.com/radrep/id36.htm

SalterSalter--Harris Type IV (10%)Harris Type IV (10%)

Fracture through epiphysis, Fracture through epiphysis, physisphysis, and , and metaphysismetaphysisAlso chronic disability because of Also chronic disability because of articulararticularsurface involvementsurface involvementDamage to growing cartilage can cause Damage to growing cartilage can cause premature fusion of bonepremature fusion of boneSurgery required to realign growth plateSurgery required to realign growth platePoor prognosis, high risk of growth Poor prognosis, high risk of growth disturbance disturbance

SalterSalter--Harris Type IVHarris Type IV

http://xray.20m.com/photo4.htmleMedicine – Salter-Harris Fractures : Article by William Moore, MD

SalterSalter--Harris Type IVHarris Type IV

http://members.fortunecity.com/radrep/id36.htm

SalterSalter--Harris Type V (<1%)Harris Type V (<1%)

RareRareTypical history of axial loadTypical history of axial loadCrush injury of growth plate, no damage to Crush injury of growth plate, no damage to epiphysis or epiphysis or metaphysismetaphysisPoor prognosis, almost inevitable growth Poor prognosis, almost inevitable growth disturbancedisturbanceDiagnosis difficult, often made after Diagnosis difficult, often made after premature closure of growth plate seenpremature closure of growth plate seen

SalterSalter--Harris Type VHarris Type V

eMedicine – Salter-Harris Fractures : Article by William Moore, MD

http://www.hawaii.edu/medicine/pediatrics/pemxray/v1c18.html

SalterSalter--Harris Type VHarris Type V

http://members.fortunecity.com/radrep/id36.htm

SourcesSourceshttp://www.hawaii.edu/medicine/pediatrics/pemxray/v1c18.htmlhttp://www.hawaii.edu/medicine/pediatrics/pemxray/v1c18.htmlRadiology Cases in Pediatric Emergency Medicine Radiology Cases in Pediatric Emergency Medicine Volume 1, Case 18 Volume 1, Case 18 Loren G. Yamamoto, MD, MPH Loren G. Yamamoto, MD, MPH Stanley M.K. Chung, MD Stanley M.K. Chung, MD AlsonAlson S. S. InabaInaba, MD , MD KapiolaniKapiolani Medical Center For Women And Children Medical Center For Women And Children University of Hawaii John A. Burns School of MedicineUniversity of Hawaii John A. Burns School of Medicine

http://orthopedics.about.com/cs/generalinfo4/a/salterharris.htmhttp://orthopedics.about.com/cs/generalinfo4/a/salterharris.htmSalterSalter--Harris Fracture ClassificationHarris Fracture ClassificationJonathan Jonathan CluettCluett, MD, MD

eMedicineeMedicine –– SalterSalter--Harris Fractures : Article by William Moore, MDHarris Fractures : Article by William Moore, MD