View source for Salter-Harris fractures

==Background==
*The higher the classification, the higher the likelihood of growth abnormalities
*If physis fracture missed may lead to premature closure and bone growth arrest
*It was previously taught that ligaments are stronger than bones in kids (and fractures were more likely than sprains), however newer studies ([[Radiograph-negative ankle injury (peds)|to date in ankles]]) contradict that assumption<ref>Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012; 94(13):1234-1244.</ref>

===Mnemonic===
*S 1 - Slipped (through physis/growth plate)
*A 2 - Above (physis with metaphysis fracture)
*L 3 - Lower (physis  with epiphysis fracture)
*T 4 - Through (physis, metaphysis and epiphysis fracture)
*R 5 - Rammed (growth plate crushed)

===Fracture Chart===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Type'''
| align="center" style="background:#f0f0f0;"|'''I (Slip)'''
| align="center" style="background:#f0f0f0;"|'''II (Above)'''
| align="center" style="background:#f0f0f0;"|'''III (Below)'''
| align="center" style="background:#f0f0f0;"|'''IV (Through)'''
| align="center" style="background:#f0f0f0;"|'''V (Crush)'''
|-
| Fracture Location||hypertrophic zone of physis (epiphysis separates from metaphysis)||Through physis and out through piece of metaphyseal bone||Intra-articular||Starts at articular surface and extends through epiphysis, physis, metaphysis||Physis compression
|-
| Pathophysiology||Growing cells remain on the epiphysis in continuity with blood supply||Growing cells remain on the epiphysis in continuity with blood supply||fracture extends from epiphysis through physis||||
|-
| Epidemiology||Occurs mostly in infants and todlers||Most common type of fracture||||||Typically occurs at knee or ankle
|-
| Prognosis||Good||Good||Moderate||Moderate||Highest chance of growth arrest
|-
|}

==Clinical Features==
*Trauma with point tenderness over a non-closed (pediatric) physis

==Differential Diagnosis==
*Sprain
*Contusion
*Other fracture

==Evaluation==
[[File:Salter_Harris.jpg|thumb|Salter Harris Types]]
===Type 1 (Slip)===
*Suspect if point tenderness over a physis
*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)
*Often radiograph negative

===Type 2 (Above)===
*X-ray shows triangular fragment of metaphysis with out injury to epiphysis

===Type 3 (Below)===
*X-ray shows epiphyseal fragment not associated with etaphyseal fracture
*Greater the displacement greater chance of vascular supply compromise

===Type 4 (Both)===
*fracture starts at articular surface and extends through epiphysis, physis, metaphysis

===Type 5 (Crush)===
[[File: Salter_harris.JPG|thumb|Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis]]
*X-ray shows physis compression fracture
**May confuse for Type 1 injury: differentiation based on clinical presentation, history, and exam.
**X-ray findings may be minimal

==Management==
{{General Fracture Management}}

===Type I===
Radiograph-negative ankle injury (peds)
Low risk mechanism
*Most: Removable brace <ref name="removable"/><ref> Ilene Claudius MD, David Newman MD. (Sept. 2015). EMRAP. https://www.emrap.org/episode/september/pediatricpearls</ref><ref>Yeung DE, Jia X, Miller CA, Barker SL. Interventions for treating ankle fractures in children. Cochrane Database Syst Rev. 2016 Apr 1;4(4):CD010836. doi: 10.1002/14651858.CD010836.pub2. PMID: 27033333; PMCID: PMC7111433.</ref><ref>Yeung DE, Jia X, Miller CA, Barker SL. Interventions for treating ankle fractures in children. Cochrane Database Syst Rev. 2016 Apr 1;4(4):CD010836. doi: 10.1002/14651858.CD010836.pub2. PMID: 27033333; PMCID: PMC7111433.</ref>
**Return to activities as tolerated by pain
**Follow up with pediatrician

===Type II===
*Most: Splint, ortho follow up
*Ankle injury - Consider removable ankle brace<ref name="removable"> Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, Schuh S. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007;119(6): e1256-e1263.</ref>

===Type III-V===
*Splint, ortho consult

==Disposition==
*Outpatient

==See Also==
*[[Fractures]]
*[[Radiograph-negative ankle injury (peds)]]
*[[Triplane fracture]] (type IV fracture of distal tibia)

==External Links==
*POSNA (Pediatric Orthopaedic Society of North America) - http://orthoinfo.aaos.org/topic.cfm?topic=A00040

==References==
<references/>

[[Category:Pediatrics]]
[[Category:Orthopedics]]