This is a nice example of a Salter-Harris type 4 fracture with the fracture line passing obliquely through the epiphysis, physis and metaphysis on this oblique left ankle radiograph. Lateral radiograph of the index finger demonstrates a nondisplaced Salter-Harris type 2 fracture through the metaphysis of the right 2nd distal phalanx. Frontal radiograph of the index finger demonstrates subtle fracture in the proximal phalanx. Note dorsal translocation of the epiphysis over the growth plate. Salter 1 fracture of the left distal radius. the epiphysis), TE (through everything –all three elements), R (rammed or crushed). the metaphysis), L (lower –involves the growth plate and the structure below or lower than the growth plate, i.e. S (separated), A (above or away from the joint –involves the growth plate and the structure above the growth plate, i.e. This can be remembered by the mnemonic – S A L TE R (14). Type 5 injuries are seen when the growth plate is severely crushed under high axial load stress. Type 4 fractures involve all three elements –metaphysis, physis and epiphysis. Type 3 fractures in turn, involve the physis and the epiphysis. Type 2 fractures, the most common type, traverse the physis and the metaphysis. Type 1 is through the growth plate, separating the metaphysis and epiphysis. Note that this classification system is only for injuries involving the growth plate. Long bones are the other common site of trauma in the young child and the distinctive mechanistic properties of the pediatric bone – namely, that it is less stiff and more able to absorb energy before fracturing – make plastic deformation the more typical manifestation than complete bone breaks. In this review, we will discuss the Salter Harris classification used for classification of all physial fractures. Essentially, you should be able to roll a small marble along the cortex of the bone you’re looking at without it bumping into anything or deviating from its smooth path along the bony margins. Another common teaching tip is the so-called MARBLE TEST for detecting subtle cortical fractures. Look carefully at the physis for any widening. Because the physis is a unique, critical structure in the young skeleton – it is important to be on the lookout for injury to the growth plate not only because it is required to enable future bone growth and any physial disruption can cause devastating deranged growth but also because the cartilaginous physis is weaker, it is more fragile and prone to injury than the ligamentous structures. Unlike adults, however, children possess growing skeletons which means trauma affects the young child slightly differently when compared to an adult leading to variations in fracture patterns, locations and consequent sequelae of injury. How does it happen?īones break secondary to moderate to severe acute trauma. Plain film radiography remains the mainstay of the imaging armory in keeping with the as low as reasonably achievable (ALARA) principle of ionizing radiation. Approximately 1 in 3 children are brought to the emergency department after acute trauma (13) due to the generally active lifestyles most adolescents and children have.
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