Salter-Harris fractures - Revision history

Zbuchwald: /* Evaluation */

2022-09-13T04:49:05Z

Evaluation

← Older revision		Revision as of 04:49, 13 September 2022
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	*Suspect if point tenderness over a physis		*Suspect if point tenderness over a physis
	*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)		*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)
			*Often radiograph negative

	===Type 2 (Above)===		===Type 2 (Above)===
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	[[File: Salter_harris.JPG\|thumb\|Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis]]		[[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		*X-ray shows physis compression fracture
	**May confuse for Type 1 injury		**May confuse for Type 1 injury: differentiation based on clinical presentation, history, and exam.
	**X-ray findings may be minimal		**X-ray findings may be minimal

Zbuchwald: /* Management */

2022-09-13T04:47:28Z

Management

← Older revision		Revision as of 04:47, 13 September 2022
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	===Type I===		===Type I===
	*Most: Splint, ortho follow up		Radiograph-negative ankle injury (peds)
	*[[Radiograph-negative ankle injury (peds)~~\|Lateral ankle]]:~~		Low risk mechanism
	**Removable ankle ~~brace~~		*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		**Return to activities as tolerated by pain
	**~~No ortho followup~~		**Follow up with pediatrician

	===Type II===		===Type II===
	*Most: Splint, ortho follow up		*Most: Splint, ortho follow up
	*Ankle~~: Removable~~ ankle brace<ref>. 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>		*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===		===Type III-V===

Rossdonaldson1: /* Management */

2019-09-18T05:18:49Z

Management

← Older revision		Revision as of 05:18, 18 September 2019
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	==Management==		==Management==
			{{General Fracture Management}}

	===Type I===		===Type I===
	*Most: Splint, ortho follow up		*Most: Splint, ortho follow up

Lisayee25: /* Mnemonic */

2018-05-25T02:35:52Z

Mnemonic

← Older revision		Revision as of 02:35, 25 May 2018
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	===Mnemonic===		===Mnemonic===
	*S 1 - Slipped (~~thru epiphysis~~)		*S 1 - Slipped (through physis/growth plate)
	*A 2 - Above (~~epiphysis~~ with metaphysis fracture)		*A 2 - Above (physis with metaphysis fracture)
	*L 3 - Lower (~~thru~~ epiphysis)		*L 3 - Lower (physis with epiphysis fracture)
	*T 4 - Through (~~epinephrine~~ and ~~meta~~)		*T 4 - Through (physis, metaphysis and epiphysis fracture)
	*R 5 - Rammed (growth plate crushed)		*R 5 - Rammed (growth plate crushed)

Rossdonaldson1: /* See Also */

2018-03-19T17:57:00Z

Rossdonaldson1 at 17:41, 18 March 2018

2018-03-18T17:41:50Z

← Older revision		Revision as of 17:41, 18 March 2018
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	==See Also==		==See Also==
	*[[Fractures]]		*[[Fractures]]
			*[[Radiograph-negative ankle injury (peds)]]

	==External Links==		==External Links==

Josgood: /* Type 4 (Both) */

2017-12-15T07:12:01Z

Type 4 (Both)

← Older revision		Revision as of 07:12, 15 December 2017
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	===Type 4 (Both)===		===Type 4 (Both)===
	*fracture starts at articular surface and extends through epiphysis, physis, ~~metaphysics~~		*fracture starts at articular surface and extends through epiphysis, physis, metaphysis

	===Type 5 (Crush)===		===Type 5 (Crush)===

Josgood: /* Fracture Chart */

2017-12-15T07:10:54Z

Fracture Chart

← Older revision		Revision as of 07:10, 15 December 2017
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	\| align="center" style="background:#f0f0f0;"\|'''V (Crush)'''		\| 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, ~~metaphysics~~\|\|Physis compression		\| 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\|\|\|\|		\| 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\|\|\|\|

Rossdonaldson1: /* Management */

2017-02-17T19:56:51Z

Management

← Older revision		Revision as of 19:56, 17 February 2017
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	===Type I===		===Type I===
	*Most: Splint, ortho follow up		*Most: Splint, ortho follow up
	*[[Radiograph-negative ankle injury (peds)\|~~lateral~~ ankle]]:		*[[Radiograph-negative ankle injury (peds)\|Lateral ankle]]:
	**Removable ankle brace		**Removable ankle brace
	**Return to activities as tolerated by pain		**Return to activities as tolerated by pain

Rossdonaldson1: /* Evaluation */

2017-02-17T19:55:58Z

Evaluation

← Older revision		Revision as of 19:55, 17 February 2017
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	[[File:Salter_Harris.jpg\|thumb\|Salter Harris Types]]		[[File:Salter_Harris.jpg\|thumb\|Salter Harris Types]]
	===Type 1 (Slip)===		===Type 1 (Slip)===
	*fracture through hypertrophic zone of physis (epiphysis separates from metaphysis)
	**Growing cells remain on the epiphysis in continuity with blood supply
	***Good prognosis
	*Occurs mostly in infants and todlers
	*Suspect if point tenderness over a physis		*Suspect if point tenderness over a physis
	*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)		*X-ray findings are subtle (epiphyseal displacement) or absent (clinical diagnosis)

	===Type 2 (Above)===		===Type 2 (Above)===
	*Most common type of fracture
	*fracture through physis and out through piece of metaphyseal bone
	**Growing cells remain on the epiphysis in continuity with blood supply
	**Good prognosis
	*X-ray shows triangular fragment of metaphysis with out injury to epiphysis		*X-ray shows triangular fragment of metaphysis with out injury to epiphysis

	===Type 3 (Below)===		===Type 3 (Below)===
	*Intra-articular fracture
	**fracture extends from epiphysis through physis
	*X-ray shows epiphyseal fragment not associated with etaphyseal fracture		*X-ray shows epiphyseal fragment not associated with etaphyseal fracture
	*Greater the displacement greater chance of vascular supply compromise		*Greater the displacement greater chance of vascular supply compromise
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	===Type 5 (Crush)===		===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]]		[[File: Salter_harris.JPG\|thumb\|Salter-Harris IV fracture of the distal tibia with associated distal fibular fracture that does not involve the physis]]
	*~~Physis~~ compression fracture		*X-ray shows physis compression fracture
	**Typically occurs at knee or ankle		**May confuse for Type 1 injury
	*May confuse for Type 1 injury
	**X-ray findings may be minimal		**X-ray findings may be minimal
	*Highest chance of growth arrest
	*Suspect based on mechanism of injury, joint effusion

	==Management==		==Management==

← Older revision		Revision as of 17:57, 19 March 2018
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	*[[Fractures]]		*[[Fractures]]
	*[[Radiograph-negative ankle injury (peds)]]		*[[Radiograph-negative ankle injury (peds)]]
			*[[Triplane fracture]] (type IV fracture of distal tibia)

	==External Links==		==External Links==