A 2 year old with no past medical history presents with severe left leg pain after falling off a trampoline. He is crying and refusing to bear weight or straighten his left leg. The extremity is otherwise neurovascularly intact. An XR of his left lower leg is shown below. What’s the diagnosis and specifically what type of fracture is it?
Answer: Salter-Harris type II fracture of the proximal left tibia
- Salter-Harris fractures are fractures of the growth plate, and there are 5 types which are commonly learned with the mnemonic SALTER
| Salter Harris Type | Location | Management |
| 1 (Slipped) | Epiphysis separated from metaphysis | Brace, follow up with pediatrician |
| 2 (Above) | Extends though physis and into metaphysis | Splint, NWB, ortho follow up |
| 3 (Lower) | Extends into intra-articular space | Splint, ED ortho consult |
| 4 (Through) | Extends through metaphysis, physis, and epiphysis | Splint, ED ortho consult |
| 5 (ERased) | Physis compression | Splint, ED ortho consult |
References:
Mayersak R.J. (2020). Initial evaluation and management of orthopedic injuries. Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill.
