Bennett fracture dislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. Pediatric knee injuries orthopaedic trauma association ota. Approximately rd of salterharris fractures occur as the result of sports and 15th occur from recreational activities. Distal femoral physeal fractures are not common but have a high rate of complications. Radiographs were assessed for physeal widening, fracture lines, and bony fragments on the knee radiographs. Occult distal femoral physeal injury with disruption of. Complications bleeding tibia fracture 1 unit prbcs femur fracture 2 units prbcs pelvic fracture 3 units prbcs. The salterharris classification was proposed by salter and harris in 1963 1 and at the time of writing june 2016 remains the most widely used system for describing physeal fractures classification. Salter and harris performed extensive histologic analysis of normal physeal anatomy, fracture patterns at the physis, and physeal healing after fracture. A 9yearold girl with an occult, on plain radiography, injury of the distal femur was examined with mri 19. The salter harris classification is commonly used and easily applied to these fractures. A practitioners guide to fracture management, part 1. Harris classification, 4 this type 1 injury is a fracture through the physis, which causes separation between the epiphysis and metaphysis. Concurrent separation of the trochanteric physis can be seen in 11% to 15% of cases.
By continuing to browse this site you are agreeing to our use of cookies. In part 2, selection of fixation technique and specific techniques, identification of bone healing, and potential complications will be addressed. The physis can be subdivided into four different zones, starting from the epiphysis and extending to the metaphysis fig. Approximately 1 3rd of salter harris fractures occur as the result of sports and 1 5th occur from recreational activities. The fractures of the proximal humerus are usually salter harris type one, although an additional section of metaphyseal bone can remain attached to the humeral head, converting it to a salter harris type. It is frequent from ages 37 and is the most common type over the age of 10. The growth plate is a soft area of cartilage at the ends of long bones. Jul 07, 2009 the case of a 14yearold boy with salter harris type ii displaced fracture underwent surgery with open reduction has been described. To understand the pathomechanics of a physeal fracture, a basic understanding of growth plate histology is necessary. The most common lateral ankle fracture is a salterharris type i shi fracture of the distal fibula.
A salterharris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. In part 1 of this 2part series, fracture biomechanics, fracture classification and diagnosis, and factors to consider when selecting a fixation technique are discussed. Gartlands classification of supracondylar fracture of humerus. Salter harris iii fracture of distal tibial epiphysis in an 11yearold boy. Type 2 is the most common variety of salterharris fractures. Salterharris type ii fracture of the femoral bone in a 14. Femoral head fractures femoral neck fractures intertrochanteric fractures subtrochanteric fractures femoral shaft fractures distal femur fractures 3. When these injuries involve the physis, the most frequently used classification is that of salter and harris 1963.
Capital physeal femoral fractures are typically classified as salter harris type i. Pdf salter harris fractures of the distal femur learning. Mri protocol three patients were imaged with a 1 t extremity mr scanner orthone, oni medical systems. Case 1 patient 1, aged 11 years and 10 months, sustained a closed salter harris sh 1 fracture of her distal femur after a hyperextension injury on a trampoline figure 1. Salterharris fractures are injuries where a fracture of the metaphysis or epiphysis extends through the physis. Mri protocol three patients were imaged with a 1t extremity mr scanner orthone, oni medical systems. Spiral, oblique, or transverse fracture patterns are possible with both nonaccidental and accidental injury. Determine and accurately name the fractured bone and or dislocated jointidentify the specific location of the fracture and or dislocation. Salter harris classification assoc prof craig hacking and assoc prof frank gaillard et al. More complicated fractures, as well as fractures to the thighbone femur and shinbone tibia, may require follow.
A type ii fracture involves a break in the bone through the metaphysis and extending into the growth plate. There is a vertical fracture through the medial portion of the distal tibial epiphysis. Salter harristype injuries of the distal femur should be treated as a dislocation of the knee and therefore as a medical emergency. The fractures of the proximal humerus are usually salterharris type one, although an additional section of metaphyseal bone can remain attached to the humeral head, converting it to a salterharris type. The findings included widening of the physeal plate, perichondrial disruption, intracartilaginous fracture, and adjacent metaphyseal oedema indicating a salterharris type i. Salter harris type i fractures describe a fracture that is completely contained within the physis. Salterharris i fracture of the distal femur springerlink.
We present a case of combination of salter harris type iii and type iv injury. A salterharris fracture is a break near, through, or along the growth plate in a bone. Diaphyseal fractures can have a spiral or transverse fracture pattern. Conveniently the salterharris types can be remembered by the mnemonic saltr type i. These fractures are classified regarding what structures are involved. Type iii and iv salterharris fractures of the femur tend to occur in older foals and usually result from a fall with the limb in adduction or from an external trauma. Two views of the left thumb reveal a fracture at the. Physeal ankle fractures occur second only to distal radius fractures in frequency. There was swelling, ecchymosis, severe pain, and valgus deformity, because.
Child abuse fractures musculoskeletal medicine for. Salter harris type 1 fracture in a german shepherd dog. Fractures that are displaced more than half of the diameter of the shaft are at greater risk for growth arrest. Broad humerus, femur narrow tibia, forearm, pelvis low contact dynamic compression plates designed to limit vascular compromise by. Salter harris i fracture of the distal femur springerlink.
Lateral ankle fractures are routinely encountered in pediatric orthopedics. Fractures may be caused by trauma, by twisting due to muscle spasm, or indirect loss of leverage or by disease that results in decalcification of the bone. In greenstick fracture common in children one side of the bone is fractured and the other side bent. A coronal fracture extends through the posterior metaphysis of the distal femur red line 2. Salterharris type iii and type iv combined fracture of the.
Our case was a 15yearold boy who had a motor vehicle accident. Restoration of normal limb alignment requires fracture reduction and fixation in a nearanatomic position, without risking further damage to the growing physis. Salterharris i and ii fractures of the distal femur in children are relatively uncommon injuries but have significant implications for limb alignment and future growth. The case of a 14yearold boy with salterharris type ii displaced fracture underwent surgery with open reduction has been described. Not all fractures that extend to the growth plate are salterharris fractures. Salterharris fracture fracture that involves the epiphyseal plate or growth plate of a bone type i. Salterharris fracture an overview sciencedirect topics. The findings included widening of the physeal plate, perichondrial disruption, intracartilaginous fracture, and adjacent metaphyseal oedema indicating a salter harris type i fracture without displacement.
This usually occurs in children or adolescents and can cause functional limitations in walking and running if the fracture is in the knee or ankle or reaching and lifting if the fracture is in an upper extremity. Displaced salterharris type i distal fibula fractures. In contrast, a toddlers fracture of the femur is a common noninflicted fracture in ambulating children. Geriatric comanagement of proximal femur fractures. Salter harris i and ii fractures of the distal femur in children are relatively uncommon injuries but have significant implications for limb alignment and future growth. Within the substance of the lateral physis was a line suggestive of a horizontal fracture through the cartilage fig. Dislocations definitions dislocation complete disruption of the articular. Salterharris type i fracture radiology reference article. Salter harris fractures of the femur, types iii and iv. Tibia fracture 1 unit prbcs femur fracture 2 units prbcs. Salter harris fractures of the distal femur learning points from two cases compared article pdf available july 20 with 210 reads how we measure reads. If this fracture is seen in older dogs, particularly after minimal trauma, then incomplete ossification of the humeral condyle iohc should be considered. The salter harris classification was proposed by salter and harris in 1963 1 and at the time of writing june 2016 remains the most widely used system for describing physeal fractures.
Walmsley, in diagnosis and management of lameness in the horse second edition, 2011. They generally follow one of the patterns described in the salterharris classification. It is similar to the type 1 but with a variably sized metaphyseal fragment. In reality, the majority of fractures that involve the physis have at least a small fragment of metaphysis associated with them and are therefore type ii injuries.
The classification for distal femur fractures can be seen in figure 34. The most common lateral ankle fracture is a salter harris type i shi fracture of the distal fibula. Oct 23, 2017 treatment will depend on the type of salter harris fracture, the bone involved, and whether the child has any additional injuries. In reality, the majority of fractures that involve the physis have at least a small fragment of metaphysis associated with them and are. What you need to know about salterharris fractures. Among them, salter harris sh type ii is the most common.
The classification of physeal injuries arc journals. Salter harris type ii fractures of the distal femur radiologist. Salterharris type iii and type iv combined fracture of. In a metaanalysis of distal physeal fractures, growth disturbance was found in 36% of salter harris i fractures. Fracture distal radius salter iv hand surgery source. Salterharris fracture or growth plate fracture this is the name given to fractures that occur in the growth plates of growing children. More complicated fractures, as well as fractures to the thighbone femur and shinbone tibia, may require followup visits until the child reaches skeletal maturity. Salterharris type ii fractures of the distal femur radiologist. These are bones that are longer than they are wide. It is a common injury found in children, occurring in 15% of childhood long bone fractures. Treatment will depend on the type of salterharris fracture, the bone involved, and whether the child has any additional injuries. Patient 1, aged 11 years and 10 months, sustained a closed salter harris sh 1 fracture of her distal femur after a hyperextension injury on a trampoline. However, nondisplaced physeal injuries to the distal fibula. She was treated as per advanced trauma life support.
Sagittal fracture through the epiphysis blue line salter harris iv. Salterharris iii fracture of distal tibial epiphysis in an 11yearold boy. At the end of this lecture, participants should able able to. They may result from a single injury or may be caused by repetitive stresses on the upper and lower extremities. Salter harris type ii involve the entire physis and a part of the metaphysic. Type ii fractures usually do not cause growth problems, and are treated with immobilization.
Improve participant understanding of and ability to read basic fractures and dislocations on plain film xrays. Occult distal femoral physeal injury with disruption of the. Occult physeal injuries are typically salter harris type 1 fractures without displacement. Note the fracture fragment arrowhead which is displaced dorsally on the lateral image. This type of fracture and its classification system is. This classification can help dictate treatment as well as predict outcomes and rate of complications associated with individual fracture.
Salter harris fractures of the distal femur europe pmc. Growth disturbance is a common sequelae of distal femoral physeal fractures. Fractures and dislocations keith kenter, md assistant professor. Because pediatric patients often are examined in the ed for orthopedic problems, understanding the salterharris classifications can help when you assess children with traumatic. Patient 1, aged 11 years and 10 months, sustained a closed salter harris sh 1 fracture of her distal femur after a hyperextension injury on a trampoline figure 1. Regular followup visits to the doctor should continue for at least a year after the fracture to make sure that the growth plate is growing appropriately. Nov 29, 2017 salter harris i and ii fractures of the distal femur in children are relatively uncommon injuries but have significant implications for limb alignment and future growth. A salterharris fracture is an injury to the growth plate area of a childs bone. May 20, 2016 salter and harris performed extensive histologic analysis of normal physeal anatomy, fracture patterns at the physis, and physeal healing after fracture.
Salterharris classification radiology reference article. Salter harris type i involve the complete separation of the physis. The incidence of femoral distal growth plate fractures is considered to be approximately 1 to 6% of all growth plate fractures 6. So, in the oreo example, imagine breaking off part of the top cookie. Senior medical staff should be involved early, anklebrachial index ratio should be measured in all patients and the clinician should have a high index of suspicion for a vascular injury. Clinical approach to physeal fractures wsava20 vin. Type iii and iv salter harris fractures of the femur tend to occur in older foals and usually result from a fall with the limb in adduction or from an external trauma. They generally follow one of the patterns described in the salter harris classification. Salterharris type i fractures describe a fracture that is completely contained within the physis. Salterharris distal femur and proximal tibia fractures.
The separation results in an increased width of the physis and frequently in displacement of the epiphysis. Males sustain more physeal ankle fractures than females, predominantly from age 10 to 15 years. Point tenderness on palpation at the epiphyseal plate may indicate a fracture. The salterharris classification is commonly used and easily applied to these fractures. We present a case of combination of salterharris type iii and type iv injury. We present a case of a 9yearold girl who sustained an occult distal femoral physeal injury with disruption of the peri chondrium after a sledding accident. Fractures and dislocations university of cincinnati. Bennett fracturedislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal. Capital physeal femoral fractures are typically classified as salterharris type i. The salterharris radiologic classification system was developed in the 1960s to describe these types of fractures, based on the extent of damage to the growth plate.
Horizontal fracture through the lateral growth plate yellow 3. Salter fracture definition of salter fracture by medical. From limited reports, type ii fractures, which are not discussed in this. These types of fractures are quite common in children and may occur while playing or during an automobile crash. Salter harris fractures involve the growth plate of long bone in pediatric patients children between 10 and 15 years old. Salterharris fractures of the femur, types iii and iv. Salterharris fractures can occur in any long bone, from fingers and toes, to arm and leg bones. A simple fracture is one in which there is no contact of the broken bone with the outer air, i. Ct examination with multiplanar reconstruction was used in preoperative assessment of distal femur growth plate fracture. Popliteal and distal pulses were present, and there was no neurological deficit. Salter fracture article about salter fracture by the.
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