Salter–Harris fracture

SalterHarris

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Salter–Harris fractures are a classification system used to describe fractures that involve the epiphyseal plate or growth plate of a bone. They are exclusively seen in pediatric patients, due to the presence of growth plates which typically fuse in adulthood. These fractures are of critical concern because they can affect the future growth and development of the involved bone.

Classification

The Salter–Harris system classifies the fractures into five main types, based on the fracture's location and how it affects the growth plate:

• Type I: This fracture runs through the growth plate, causing a separation of the epiphysis from the metaphysis without breaking the bone. It has the best prognosis for normal growth.
• Type II: The most common type, this fracture runs through the growth plate and metaphysis, sparing the epiphysis. It typically heals well, but there's a small risk of growth disturbance.
• Type III: This fracture involves the epiphysis and extends to the growth plate, potentially disrupting the joint surface. It requires accurate realignment to prevent growth disturbances and joint issues.
• Type IV: A fracture that crosses through the epiphysis, growth plate, and metaphysis. This type has a high risk of growth plate closure leading to limb length discrepancies or angular deformities.
• Type V: The least common, involving a crush injury to the growth plate. It has a poor prognosis due to the high risk of premature growth plate closure.

Diagnosis

Diagnosis of Salter–Harris fractures typically involves a combination of clinical examination and imaging studies. X-rays are the primary tool for diagnosis, but sometimes MRI or CT scans are used to assess complex fractures or when the X-ray does not provide clear information.

Treatment

Treatment varies depending on the type of Salter–Harris fracture. It may include:

• Non-surgical treatment: Most Type I and II fractures can be treated with casting or splinting to immobilize the bone and allow it to heal properly.
• Surgical treatment: Type III, IV, and V fractures often require surgery to realign the bones and stabilize the growth plate. This may involve the use of pins, screws, or plates.

Prognosis

The prognosis for Salter–Harris fractures depends on the type of fracture and the adequacy of treatment. Early and appropriate management is crucial to minimize the risk of growth disturbances. Regular follow-up is necessary to monitor healing and the potential development of complications such as growth plate closure, deformity, or differences in limb length.

Prevention

Preventing Salter–Harris fractures involves minimizing risks associated with childhood injuries. This includes the use of appropriate safety equipment during sports, teaching children safe playing practices, and ensuring that physical activities are age-appropriate.