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Salter-Harris Fracture

What is a Salter-Harris fracture?

This is a break nearby or in the bone’s growth plate. The growth plate is also referred to as the physis or epiphyseal plate. A growth plate is the anatomical structure that you find at the ends of the long bones of adolescents and children. It lies between your epiphysis at the bottom and your metaphysis at the top. In these plates are cells that are rapidly dividing and allowing the bones to become longer until the end of puberty is reached. It is a fracture you will only find in children and adolescents who are still growing. When these damaged bone cells grow it could be at a decelerated or accelerated rate. This can cause a noticeable different in the length of the bones. A Salter-Harris fracture accounts for approximately fifteen percent of all long bone fractures in children and adolescents.

This type of fracture was first described in 1963 by Robert B. Salter and W Robert Harris. A Salter-Harris fracture occurs most often in the lower leg or arm or the fingers.

Classification

With Salter Harris fractures they are classified from one to nine according to the growth plate damage and the area of the bone that is fractured. Using this classification system it can help to indicate if surgery will be necessary to realign the fractured bone and stabilize it. Classification one through five are mainly the ones used and the last four classifications are rarely used.

  • Type one – the fracture passes through the growth plate but affects no other surrounding bones. It occurs in approximately six percent of these fractures and is usually seen in younger children.
  • Type two – the fracture passes above the growth plate and up through the wide portion of the long bone, called the metaphysis, but not the rounded end of the long bone at its joint, called the epiphysis. This occurs in approximately seventy-five percent of these fractures and is the most common type of this fracture, especially in older children.
  • Type three – the fracture passes below the growth plate and the epiphysis, exiting through the end of the bone and into the adjacent joint but not the metaphysis. Because the joint cartilage has been disrupted this fracture can be concerning. This occurs in approximately eight percent of these fractures. It happens more in older children.
  • Type four – the fracture starts above your growth plate then passes through it, the metaphysic, and the epiphysis, exiting through the joint cartilage. It is often associated with disrupted bone growth patterns. It can result in having a lasting disability. This occurs in approximately ten percent of these fractures
  • Type five – when this fracture occurs their growth plate is crushed between the metaphysic and the epiphysis. This fracture can cause a severe decrease in their bone growth. If it permanently injures the growth plate further treatment later may be needed to restore the alignment of the limb. This occurs in approximately one percent of these fractures.

Symptoms

  • Swelling
  • Pain
  • Tenderness
  • Change in the shape of the area that is different than what it normally looks like
  • Not being able to put weight on the leg
  • Not being able to move the injured area

Risks

Any child who is still growing can be at risk for having a Salter-Harris fracture. The highest risk groups are teenage males. Other risks can include:

  • Those involved in sports such as basketball, soccer, and football players, wrestlers, and gymnasts
  • Falls from skis, skateboards, bikes
  • Motor vehicle accidents
  • Abuse or assaults such as twists or hard pulls to the leg, arm, or fingers

Diagnosis

When it is thought that the child or adolescent has a Salter-Harris fracture they will do an x-ray but at first they may not be seen on the x-ray. In some cases it can take up to fourteen days before the physician can see them on an x-ray.

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Treatment

Because a Salter-Harris fracture may take up to fourteen days to appear on an x-ray they may put a child or adolescent in a splint or cast if it suspected they have this type of fracture to prevent any further injuring to the surrounding bone and growth plate. Once it identified as a definite Salter-Harris fracture how it is treated depends on the age of the child and on which classification it is.

  • Type one – to treat this classification they will cast it to prevent any movement of the bone. Once it has healed there is no residual bone growth problems
  • Type two – this fracture is also requires casting to prevent movement. Once it has healed, the bone growth will continue normally. The growth plates will need to be repositioned and is done under anesthesia.
  • Type three – because it goes through the epiphysis some of it may break off and require surgery to correctly realign the bone. Once it is correctly set then it will be put into a cast to immobilize it.
  • Type four – it is often necessary to have it surgically aligned to hold the fragments of bone into place before they can put the bone into a cast.
  • Type five – to stabilize the bone and resurface the joint it may be necessary to have surgery. After the cast is removed it may be necessary to do physical therapy to encourage easier mobility.

With any classification you should make sure that you are keeping the splint or cast above the level of their heart as often as you can for one to three days. Using an ice pack can also help to decrease the swelling and pain. Make sure that you do not get the cast or splint wet and check circulation often. If the child starts to feel tingling in their fingers or toes or they start to look blue or feel cold, elevate the limb and call the orthopedic doctor or family position as these can signal something is wrong.

Recovery time

The recovery time will also depend on the classification of the fracture.

  • Type one, type four, and type five – approximately four to six weeks healing time
  • Type two – approximately six weeks healing time
  • Type three – up to six weeks healing time

Complications

When a child or adolescent has a Salter-Harris fracture there is a chance that the bone may not heal at all or heal poorly. Over time the bone growth could stop or slow down with some types of these fractures. The limb that was affected could become shortened or bent and have a limited range of motion, or movement. There is also a change of developing an infection and it could also damage the blood vessels, muscles, and nerves around the bone.


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