One should consider the possibility of type V in a symptomatic child with a normal radiograph in an appropriate setting. This may be diagnosed retrospectively once growth arrest has occurred. Though Harris-Salter V fractures are very rare, they may be seen in electric shock, frostbite, and irradiation cases. As this fracture pattern tends to result from severe injury, these typically have a poor prognosis leading to bone growth arrest.īe aware that it can be radiographically occult, and thus the radiograph may appear normal. In type V, the force is transmitted through the epiphysis and physis, potentially disrupting the germinal matrix, hypertrophic region, and vascular supply. This fracture type is due to a crush or compression injury of the growth plate. Therefore, both require urgent orthopedic evaluation. Types III and IV fractures each carry a risk for growth retardation, altered joint mechanics, and functional impairment. Oblique component through the metaphysis. An example of this is a Triplane fracture at the ankle, which has the following three components: As this fracture involves the epiphysis, the articular cartilage may be damaged. This is also an intra-articular fracture, in which the fracture passes through the epiphysis, physis, and metaphysis. One example is a Tillaux fracture of the ankle, which is a fracture of the anterolateral aspect of the growth plate and epiphysis. Since the epiphysis is involved, damage to the articular cartilage may occur. If the fracture extends the complete length of the physis, this type of fracture may form two epiphyseal segments. This is an intra-articular fracture extending from the physis into the epiphysis. If it involves the distal end of the bone, the physis is distal to the metaphysis, which extends proximally from the physis into the metaphysis. If the proximal end of the bone is involved, the physis is proximal to the metaphysis, so this extends distally from the physis into the metaphysis. When the small corner of the metaphysis is visible, this is known as a corner sign or Thurston-Holland fragment.īe careful in using the terms proximal and distal to describe the extension because the position of the physis is relative to the metaphysis and is not fixed. These are most common and occur away from the joint space. These are when the fracture extends through both the physis and metaphysis. An example is Slipped Capital Femoral Epiphysis (SCFE). Diagnosis is based on clinical findings, such as the presence of focal tenderness or swelling surrounding the growth plate. Look for the widening of the physis or displacement of the epiphysis, which may suggest a fracture. A radiograph may be normal due to lack of bony involvement, and mild to moderate soft tissue swelling may be noted. Beware that a normal radiograph cannot exclude a physis injury in a symptomatic pediatric patient. Type I fractures are due to the longitudinal force applied through the physis, which splits the epiphysis from the metaphysis. This is when the fracture line extends through the physis or within the growth plate. Higher-grade Salter-Harris fractures have a higher incidence of premature physeal fusion. Ranging from I to V, lower numbers are less severe and have less of a propensity for growth abnormalities. Salter-Harris fractures include a classification system that allows providers to risk-stratify injuries.
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