Salter-Harris fractures
Salter-Harris fractures are paediatric fractures which involve the growth plate in the long bones. It is important to detect these as they may affect the growth of the bone if not treated.
There are generally five types of Salter-Harris fracture (some will say more than five but as it is quite rare to see all the main five then these will suffice). It is quite easy to remember them. For the purpose of remembering them the reader needs to imagine all long bones with the epiphysis at the base. Of course some have the epiphysis at the head but just look at these upside down. Scroll down the images on the left and read on. The graphics are there to help with each type, and included below each is a radiograph to demonstrate the appearances.
Type one is a fracture along the growth plate which may be undisplaced or appear as a widening of the growth plate but for our purposes it can also be a "Slipped epiphysis".
Type two is a fracture of the diaphysis "Above the growth plate" and is the most common.
Type three is a fracture of the epiphysis "Lower than the growth plate".
Type four is a fracture of the diaphysis and the epiphysis which communicates "Through the growth plate".
Type five is an impaction of the epiphysis into the diaphysis or a "Raised epiphysis" and is the least common and most difficult to diagnose.
Look at the two images of the wrist (courtesy of Dr. Ian Keney, Radiologist at the Royal Alexandra Children's Hospital in Brighton, U.K.) the radiograph of the right wrist shows a Salter-Harris type 5 fracture. At first glance there is little apparent damage, but compare it to the comparison view of the normal left wrist of the same patient. It should be possible now to see that there is a "sclerotic" band across the distal diaphysis of the right radius where the impaction has taken place, also a small area of bulging is seen on the ulna aspect of the distal radius. This is one injury where good comparison views are required to make the diagnosis.
The radiograph of the middle phalanx of the finger was also diagnosed as a Salter-Harris type 5. It can be seen that there is little apparent disruption of the growth plate, although it is not as lucent as that of the terminal phalanx, and no obvious fracture. Compare the base of the diaphysis of the middle phalanx to the base of the terminal phalanx, it should be apparent that the base of the diaphysis of the middle phalanx has been spread out due to the upward force of the epiphysis being impacted into it. It was argued at the time between the radiologists and the orthopaedic surgeons that this was in fact a Salter-Harris type 2, but this is the problem with the type 5 injury, it can become quite subjective when detached from the clinical assessment.
So it can be seen that Salter has been spelled out badly.....S-A-L-T-R.
Now they should never be forgotten.
