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Salter Harris Fracture Classification

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Epiphysis the two expanded ends of a long bone ... Fracture thru the physis without involvement of the bone of the epiphysis or metaphysis ... – PowerPoint PPT presentation

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Title: Salter Harris Fracture Classification


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 boneslonger in one dimension than other
    bones and consist of a shaft and two ends
  • Diaphysisthe shaft of a long bone
  • Epiphysisthe two expanded ends of a long bone
  • Metaphysisthe flared portion of the bone between
    the diaphysis and the epiphysis (it extends from
    the diaphysis to the epiphyseal line)
  • Epiphyseal platethe 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

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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)

11
Salter Harris I
12
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

13
Salter Harris II
14
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

15
Salter Harris III
16
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

17
Salter Harris IV
18
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)

19
Salter Harris V
20
References
  • Collaborative Hypertext of Radiology
    (http//chorus.rad.mcw.edu/doc/00358.html)
  • Initial Evaluation and Management of Orthopedic
    Injuries. Tintinallis Emergency Medicine.
    (http//www.accessmedicine.com.proxy.med.sc.edu/co
    ntent.aspx?aID611893searchStrsalter-harristype
    i611893)
  • 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-harriscl
    assification.htm
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