Salter-Harris Fracture: Overview, Types, Causes, Diagnosis, and Treatment

Overview

• Definition: A Salter-Harris fracture is an injury through the growth plate of a long bone, typically affecting children.
• Growth Plate: Also known as the physeal/epiphyseal plate, it's a cartilage area that contributes to bone growth until ages 14-18.
• Significance: Most common fractures in children and can cause bone deformity or growth arrest if untreated.

Types of Salter-Harris Fractures

• Type I: Fracture line runs across the growth plate; minimal impact on bone growth.
• Type II (Most Common): Fracture through growth plate and metaphysis; often in children >10 years.
• Type III: Cuts across growth plate towards epiphysis; may lead to post-traumatic arthritis.
• Type IV: Vertical fracture through growth plate; can cause asymmetric growth.
• Type V (Rarest): Damage to growth plate without a break; often missed in diagnosis.
• Types VI-IX: Very rare.

Causes

• Traumatic Events: Falls, motor vehicle collisions.
• Repetitive Pressure: Sports or high-impact activities.
• Forces:
  • Types I-III: Rotating or twisting force.
  • Types IV-V: Compression or crushing force.
  • Type V: Occasionally due to non-traumatic causes like infection.

Signs and Symptoms

• Pain: Initial symptom followed by swelling near the injured bone.
• Tenderness: Painful to touch.
• Mobility Issues: Difficulties bearing weight or limited motion.
• Deformity: Possible visible deformity.

Diagnosis

• Medical Evaluation: Includes event history, symptoms, and physical examination.
• X-ray: Commonly used but may not show Type I and V fractures.
• Clinical Suspicion: Important for Type V based on history and symptoms.

Treatment

• Initial: Control swelling and pain through elevation, icing, and NSAIDs.
• Further Treatment:
  • Type I & II: Often managed with closed reduction and casting.
  • Type III & IV: May require surgical intervention (open reduction and internal fixation).
  • Type V: Treatment varies based on severity.
• Follow-Up: Examined 7-10 days post-treatment and monitored for growth.

Key Points

• Salter-Harris fractures are prevalent growth plate injuries in children.
• Type I is least likely and Type V most likely to impact growth.
• Treatment varies from rest and splinting to surgical procedures depending on fracture type.
• Regular follow-ups are crucial to monitor healing and growth.