Epiphyseal Fractures

(Salter-Harris Fractures)
Created By :
 What are Salter Harris
fractures?
• Salter-Harris fractures are fractures
through a growth plate (physis); therefore,
they are unique to pediatric patients.
• Most commonly involve ankle and wrist
• The classification of the injury is important
because it affect the treatment of the
patient and provides clues to possible
long-term complications.
 PHYSEAL INJURIES
• Many childhood fractures involve the
physis
– 20% of all skeletal injuries in children
– Can disrupt growth of bone
– Injury near but not at the physis can stimulate
bone to grow more
 Relevance
• Nearly 20% of
children who
present with an
injury have a
fracture
– 42% boys, 27%
girls will sustain
fracture in
childhood
Anatomy
 Histologic Review
• Important for
understanding prognosis
• The germinal layer of the
cartilage is on the
epiphysis
• Cartilage cells grow from
the epiphysis towards the
metaphysis. The
fragments of cells then
mineralize.
Physical Exam Findings
• Edema
• Limited range of motion in joint
• Point tenderness over the growth plate
Radiographs...

• Need AP and lateral that include the joints

proximal and distal to point of injury
• Comparison study of contra lateral limb
 Classifications
I
– pure epiphyseal separation
– if non-displaced, joint effusion may be only sign
II
– metaphyseal fracture + epiphyseal separation
III
– epiphyseal fracture
IV
– vertically oriented fx thru epiphysis + metaphysis
V
– crush injury of epiphysis (not detected acutely)
 Type I
• Widening of the growth plate
• Fracture passes transversely through physis
separating epiphysis from metaphysis
• “Slipped epiphysis”
 Type II
• Fracture of metaphysis
• “Above the growth plate”
 Type III
• Fracture of the epiphysis
• “Lower than the growth plate”
 Type IV
• Fracture of the metaphysis and epiphysis
that communicate
• “Through the growth plate”
 Type V
• Impaction of epiphysis into the diaphysis
• “Raised epiphysis”
Left Right
 Mnemonic
• S – "Slipped epiphysis“
• A – "Above the growth plate"
• L – "Lower than the growth plate"
• T – "Through the growth plate“
(E)
• R – "Raised epiphysis"

W. Robert Salter, MD
 Prognose
• The prognosis of physeal fractures
depends on :
– Types of fractures
– Age
– Blood suply around the epiphysis
– Reduction methode
– Types of wound (open/closed fractures)
 Final thoughts
• Type II is most common
• Types III & IV are more prone to chronic
disability
• Type V associated with growth
disturbances and has a poor functional
prognosis
• Only 2% of Salter-Harris fractures result in
a significant functional disturbance
 Special thanks to…
• people breaking bones, who made this
presentation possible