Imaging Case: Answer
Answer: B. Salter-Harris Fracture Type II
In a patient with open growth plates, the Salter Harris Classification is used for description and prognostication.
- 5-7% of growth plate injuries
- The epiphysis separates from the metaphysis. There are few growth disturbances that follow. Any child with point tenderness at a growth plate, without radiologic evidence of injury by definition has a Salter Harris I fracture.
- While some FOAM literature has began to question the validity of this type of fracture and while many orthopedic surgeons will discontinue the cast, the standard of emergency medical care remains splinting, immobilization and orthopedic follow-up.
- 75% of growth plate injuries
- Fracture line cuts across the growth plate and through the metaphysis.
- This injury is usually seen with a triangular piece of metaphysis and not associated with obvious epiphyseal injury.
- Treatment is closed reduction as needed, immobilization and orthopedic follow up.
- 7-10% of growth plate injuries
- Fracture line extends through the intra-articular space, from epiphysis through physis, to the periphery.
- Management in the ED typically involves an orthopedic consult while patient is in the ED.
- 10% of growth plate injuries. This injury can has poor prognosis.
- Fracture line goes through the articular surface, epiphysis, physis and the metaphysis.
- Orthopedics consult in the ED is typically required for precise closed reduction. Patient will eventually received open reduction with fixation.
- Uncommon, <1% of growth plate injuries
- Injury typically occurs in the knee or ankle, with crushing and compression of the growth plate.
- These injuries are difficult to evaluate radiographically, and have poor prognosis.
1. Black KL, Duffy C, Hopkins-Mann C, Ogunnaiki-Joseph D, Moro-Sutherland D. Musculoskeletal Disorders in Children. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016.
2. McQuillen, K. "Musculoskeletal Disorders." In: Rosen's Emergency Medicine, 8e. Chapter 176. Pages 2250-70.
3. Galliard et al. "Salter-Harris classification." Radiopedia.org. 2017.