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Salter Harris Fracture Classification

Salter Harris Fracture Classification. Melissa L. Harris March 27, 2007. What are Salter fractures?. Fractures involving the epiphyseal plate at the end of the long bone of a growing child

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Salter Harris Fracture Classification

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  1. Salter Harris Fracture Classification Melissa L. Harris March 27, 2007

  2. What are Salter fractures? • Fractures involving the epiphyseal plate at the end of the long bone of a growing child • Growth plate fractures account for 15-20% of major long bone fractures and 34% of hand fractures in childhood • Classified into 5 types based on fracture line

  3. Why is this important? • The type generally correlates with the potential for future growth disturbance (and consequently the aggressiveness of treatment required)

  4. Anatomy • Long bones—longer in one dimension than other bones and consist of a shaft and two ends • Diaphysis—the shaft of a long bone • Epiphysis—the two expanded ends of a long bone • Metaphysis—the flared portion of the bone between the diaphysis and the epiphysis (it extends from the diaphysis to the epiphyseal line) • Epiphyseal plate—the disk of cartilage between the metaphysis and the epiphysis of an immature long bone permitting growth in length

  5. Anatomy Review

  6. Salter Harris Growth Plate Fracture Classification Type What is Broken Off • I: The entire epiphysis • II: Entire epiphysis + portion of the metaphysis • III: Portion of the epiphysis • IV: Portion of the epiphysis + portion of the metaphysis • V: Nothing “broken off;” compression injury of the epiphyseal plate

  7. Salter Harris I • Fracture thru the physis without involvement of the bone of the epiphysis or metaphysis • May be radiologically undetectable • Dx is usually clinical based on swelling and tenderness in the region of the physis • Growth plate remains attached to the epiphysis • Likelihood that bone will grow normally is excellent (unless there is damage to the blood supply of the growth plate)

  8. Salter Harris I

  9. Salter Harris II • Fracture involving part of the metaphysis and extending to the physis • Most common type • Usually caused by a fixed supination and external rotation force • Typically reset and immobilized

  10. Salter Harris II

  11. Salter Harris III • Fracture involving the epiphysis and extending to the physis • Occurs only rarely (usually at the lower end of the tibia) • Surgery sometimes necessary • Prognosis is good if the blood supply to the separated portion of the epiphysis is still intact and if the fracture is not displaced

  12. Salter Harris III

  13. Salter Harris IV • Fracture involving the epiphysis, metaphysis, and extending to the physis • Surgery is needed (restore joint surface/align growth plate) • Occurs most commonly at the end of the humerus near the elbow • Prognosis for growth is poor, unless perfect alignment is achieved and maintained during healing

  14. Salter Harris IV

  15. Salter Harris V • Occurs when the end of the bone is crushed and the growth plate compressed • Uncommon • May be radiologically undetectable • May be evident only retrospectively when growth disturbance first begins to appear • Hx of significant axial loading force and significant tenderness in the area of the epiphyseal plate, should suggest the possibility of a type V injury • Occurs most likely at the knee or ankle • Prognosis is poor (premature stunting of growth is almost inevitable)

  16. Salter Harris V

  17. References… • Collaborative Hypertext of Radiology (http://chorus.rad.mcw.edu/doc/00358.html) • “Initial Evaluation and Management of Orthopedic Injuries.” Tintinalli’s Emergency Medicine. (http://www.accessmedicine.com.proxy.med.sc.edu/content.aspx?aID=611893&searchStr=salter-harris+type+i#611893) • Green: Skeletal Trauma in Children 3rd ed. Elseiver. 2003. • Ross, M. Histology a Text and Atlas. 2003. • http://members.aol.com/PTdoctor/salter-harris.html • http://www1bpt.bridgeport.edu/~gwl/salter-harrisclassification.htm

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