Salter–Harris fracture

Salter–Harris fractures
Other names: Growth plate fracture[1]
An X-ray of the left ankle showing a Salter–Harris type III fracture of medial malleolus. Red arrow demonstrates fracture line while the blue arrow marks the growth plate.
SpecialtyOrthopedics

Salter–Harris fracture is a bone fracture involving the growth plate.[2] It is thus a form of child bone fracture.

It is a common injury found in children, occurring in 15% of childhood long bone fractures.[3] This type of fracture and its classification system is named for Robert B. Salter and William H. Harris who created and published this classification system in 1963.[4]

Types

Salter–Harris fracture types

There are nine types of Salter–Harris fractures; types I to V were originally described,[3] and types VI to IX were added subsequently:[5]

  • Type I – transverse fracture through the growth plate (also referred to as the "physis"):[6] 6% incidence
  • Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis:[7] 75% incidence, takes approximately 12-90 weeks or more in the spine to heal.[8]
  • Type III – A fracture through growth plate and epiphysis, sparing the metaphysis:[9] 8% incidence
  • Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis:[10] 10% incidence
  • Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray):[11] 1% incidence
  • Type VI – Injury to the peripheral portion of the physis and a resultant bony bridge formation which may produce an angular deformity (added in 1969 by Mercer Rang)[12]
  • Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)[13]
  • Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossification
  • Type IX – Injury of the periosteum which may impair intramembranous ossification

Mnemonic

The mnemonic "SALTER" can be used to help remember the first five types.[14][15][16]

N.B.: This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

  • I – S = "Slip (separated or straight across)". Fracture of the cartilage of the physis (growth plate)
  • II – A = "Above". The fracture lies above the physis, or "away" from the joint.
  • III – L = "Lower". The fracture is below the physis in the epiphysis.
  • IV – TE = "Through everything". The fracture is through the metaphysis, physis, and epiphysis.
  • V – R = "Rammed (crushed)". The physis has been crushed.

Alternatively, SALTER can be used for the first 6 types, as above but adding Type V — 'E' for 'Everything' or 'Epiphysis' and Type VI — 'R' for 'Ring'.

Prognosis

Fractures in children generally heal relatively fast but may take several weeks to heal.[1] Most growth plate fractures heal without any lasting effects.[1] Rarely, bridging bone may form across the fracture, causing stunted growth and/or curving.[1] In such cases, the bridging bone may need to be surgically removed.[1] A growth plate fracture may also stimulate growth, causing a longer bone than the corresponding bone on the other side.[1] Therefore, the American Academy of Orthopaedic Surgeons recommends regular follow-up for at least a year after a growth plate fracture.[1]

History

Types I to V were described by Robert B Salter and W Robert Harris in 1963,[3] and the rarer types VI to IX were added subsequently.[17]

See also

References

  1. 1 2 3 4 5 6 7 "Growth Plate Fractures". orthoinfo.aaos.org, by the American Academy of Orthopaedic Surgeons. Archived from the original on 2018-02-05. Retrieved 2018-02-05. Last Reviewed: October 2014
  2. ↑ Cepela, Daniel J.; Tartaglione, Jason P.; Dooley, Timothy P.; Patel, Prerana N. (November 2016). "Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures". Clinical Orthopaedics and Related Research. 474 (11): 2531–2537. doi:10.1007/s11999-016-4891-3. ISSN 0009-921X. PMC 5052189. PMID 27206505.
  3. 1 2 3 Salter RB, Harris WR (1963). "Injuries Involving the Epiphyseal Plate". J Bone Joint Surg Am. 45 (3): 587–622. doi:10.2106/00004623-196345030-00019. Archived from the original on October 14, 2013. Retrieved October 13, 2013.
  4. ↑ Cepela, DJ; Tartaglione, JP; Dooley, TP; Patel, PN (November 2016). "Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures". Clinical orthopaedics and related research. 474 (11): 2531–2537. doi:10.1007/s11999-016-4891-3. PMID 27206505.
  5. ↑ Salter-Harris Fracture Imaging at eMedicine
  6. ↑ "S.H. Type I – Wheeless' Textbook of Orthopaedics". Wheelessonline.com. September 13, 2011. Archived from the original on August 22, 2013. Retrieved August 27, 2013.
  7. ↑ "S.H. Type II – Wheeless' Textbook of Orthopaedics". Wheelessonline.com. September 13, 2011. Archived from the original on August 22, 2013. Retrieved August 27, 2013.
  8. ↑ Mirghasemi, Alireza; Mohamadi, Amin; Ara, Ali Majles; Gabaran, Narges Rahimi; Sadat, Mir Mostafa (November 2009). "Completely displaced S-1/S-2 growth plate fracture in an adolescent: case report and review of literature". Journal of Orthopaedic Trauma. 23 (10): 734–738. doi:10.1097/BOT.0b013e3181a23d8b. ISSN 1531-2291. PMID 19858983. S2CID 6651435.
  9. ↑ "Salter Harris Type III Frx – Wheeless' Textbook of Orthopaedics". Wheelessonline.com. September 13, 2011. Archived from the original on August 22, 2013. Retrieved August 27, 2013.
  10. ↑ "Salter Harris: Type IV – Wheeless' Textbook of Orthopaedics". Wheelessonline.com. September 13, 2011. Archived from the original on August 22, 2013. Retrieved August 27, 2013.
  11. ↑ "Type V – Wheeless' Textbook of Orthopaedics". Wheelessonline.com. September 13, 2011. Archived from the original on August 22, 2013. Retrieved August 27, 2013.
  12. ↑ Rang, Mercer, ed. (1968). The Growth Plate and Its Disorders. Harcourt Brace/Churchill Livingstone. ISBN 978-0-443-00568-8.
  13. ↑ Ogden, John A. (October 1, 1982). "Skeletal Growth Mechanism Injury Patterns". Journal of Pediatric Orthopaedics. 2 (4): 371–377. doi:10.1097/01241398-198210000-00004. PMID 7142386. S2CID 31281905.
  14. ↑ Davis, Ryan (2006). Blueprints Radiology. ISBN 9781405104609. Archived from the original on May 14, 2022. Retrieved March 3, 2008.
  15. ↑ "Salter-Harris Fractures". OrthoConsult. February 5, 2017. Archived from the original on 8 December 2017. Retrieved 5 February 2017.
  16. ↑ Tidey, Brian. "Salter-Harris Fractures". Archived from the original on April 24, 2008. Retrieved March 3, 2008.
  17. ↑ Salter-Harris Fracture Imaging at eMedicine
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