Tài liệu SALTER-HARRIS FRACTURE Alex Duckworth, MS4 What is a Salter-Harris fracture? Fracture through ppt

SALTER
SALTER
-
-
HARRIS
HARRIS
FRACTURE
FRACTURE
Alex Duckworth, MS4
Alex Duckworth, MS4
What is a Salter
What is a Salter
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-
Harris fracture?
Harris fracture?
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
Fracture through growth plate in a pediatric
Fracture through growth plate in a pediatric
patient
patient


35 % of skeletal injuries in patients aged 10
35 % of skeletal injuries in patients aged 10
-
-
15
15
involve growth plate

involve growth plate


Often due to trauma, usually sports
Often due to trauma, usually sports
-
-
related or
related or
fall
fall
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
Complain of point tenderness around fracture
Complain of point tenderness around fracture
site
site


Soft
Soft
-
-
tissue swelling on physical exam
tissue swelling on physical exam
Anatomy of Long Bones
Anatomy of Long Bones
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
Epiphysis distal to the

Epiphysis distal to the
physis
physis
(growth
(growth
plate)
plate)


Metaphysis
Metaphysis
on opposite side of
on opposite side of
physis
physis
from epiphysis
from epiphysis


Diaphysis
Diaphysis
is long shaft beyond
is long shaft beyond
metaphysis
metaphysis
Normal Pediatric Long Bone
Normal Pediatric Long Bone
eMedicine – Salter-Harris Fractures : Article by William
Moore, MD
Bone Growth

Bone Growth
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Cartilage growth from epiphysis towards
Cartilage growth from epiphysis towards
metaphysis
metaphysis


Neovascularization
Neovascularization
and primary bone formation
and primary bone formation
occurs from
occurs from
metaphysis
metaphysis
towards epiphysis,
towards epiphysis,
immature bone remodeled
immature bone remodeled


Physis
Physis
closes when vascular supplies of
closes when vascular supplies of
metaphysis
metaphysis
and epiphysis touch

and epiphysis touch


Disruption of vasculature can cause growth
Disruption of vasculature can cause growth
deformities
deformities


Classification of fractures impacts treatment
Classification of fractures impacts treatment
options and prognosis/complications
options and prognosis/complications
Overview of Classification
Overview of Classification
Adapted from Disorders and Injuries of the Musculoskeletal System, 3rd Edition. Robert
B. Salter, Baltimore, Williams and Wilkins, 1999.
Salter
Salter
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-
Harris Type I (5%)
Harris Type I (5%)
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
Transverse fracture through
Transverse fracture through
physis
physis



Width of
Width of
physis
physis
increased
increased


Most critical part of growth plate usually
Most critical part of growth plate usually
remains attached to epiphysis
remains attached to epiphysis


Normally just casting while fracture heals
Normally just casting while fracture heals


Good prognosis for normal growth
Good prognosis for normal growth
Salter
Salter
-
-
Harris Type I
Harris Type I
eMedicine – Salter-Harris
Fractures : Article by William
Moore, MD

/case6/index.htm
Salter
Salter
-
-
Harris Type I
Harris Type I
/>salter-harris.html
/>rep/id36.htm
Salter
Salter
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-
Harris Type II (75%)
Harris Type II (75%)


Most common
Most common


Fracture through
Fracture through
physis
physis
as well as
as well as
metaphysis
metaphysis



No
No
epiphyseal
epiphyseal
involvement
involvement


Usually requires manipulation of fracture
Usually requires manipulation of fracture
back into position and immobilization for
back into position and immobilization for
normal growth
normal growth
Salter
Salter
-
-
Harris Type II
Harris Type II
eMedicine – Salter-Harris
Fractures : Article by William
Moore, MD
www.mevis.de/~hhj/TraumaRad/TraumaRa
dHiRes.htm
Salter
Salter
-
-

Harris Type II
Harris Type II
eMedicine – Salter-Harris Fractures :
Article by William Moore, MD
www.uth.tmc.edu/radiology/test/er
_primer/shoulder/sh29.html
Salter
Salter
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-
Harris Type III (10%)
Harris Type III (10%)
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
Fracture involving
Fracture involving
physis
physis
and epiphysis
and epiphysis


Usually causes damage to reproductive
Usually causes damage to reproductive
part of
part of
physis
physis



Chronic disability because of involvement
Chronic disability because of involvement
of
of
articular
articular
surface
surface


Commonly requires surgery
Commonly requires surgery


Good prognosis for normal growth if blood
Good prognosis for normal growth if blood
supply not disrupted to epiphysis and
supply not disrupted to epiphysis and
fracture non
fracture non
-
-
displaced
displaced
Salter
Salter
-
-
Harris Type III
Harris Type III

eMedicine – Salter-Harris Fractures :
Article by William Moore, MD
/>rics/pemxray/v1c18.html
Salter
Salter
-
-
Harris Type III
Harris Type III
/>Salter
Salter
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-
Harris Type IV (10%)
Harris Type IV (10%)


Fracture through epiphysis,
Fracture through epiphysis,
physis
physis
, and
, and
metaphysis
metaphysis


Also chronic disability because of
Also chronic disability because of
articular

articular
surface involvement
surface involvement


Damage to growing cartilage can cause
Damage to growing cartilage can cause
premature fusion of bone
premature fusion of bone


Surgery required to realign growth plate
Surgery required to realign growth plate


Poor prognosis, high risk of growth
Poor prognosis, high risk of growth
disturbance
disturbance
Salter
Salter
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-
Harris Type IV
Harris Type IV
/>eMedicine – Salter-Harris
Fractures : Article by William
Moore, MD
Salter
Salter

-
-
Harris Type IV
Harris Type IV
/>Salter
Salter
-
-
Harris Type V (<1%)
Harris Type V (<1%)
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Rare
Rare


Typical history of axial load
Typical history of axial load


Crush injury of growth plate, no damage to
Crush injury of growth plate, no damage to
epiphysis or
epiphysis or
metaphysis
metaphysis


Poor prognosis, almost inevitable growth
Poor prognosis, almost inevitable growth

disturbance
disturbance


Diagnosis difficult, often made after
Diagnosis difficult, often made after
premature closure of growth plate seen
premature closure of growth plate seen
Salter
Salter
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-
Harris Type V
Harris Type V
eMedicine – Salter-Harris Fractures :
Article by William Moore, MD
/>atrics/pemxray/v1c18.html
Salter
Salter
-
-
Harris Type V
Harris Type V
/>Sources
Sources


/> />Radiology Cases in Pediatric Emergency Medicine
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 18

Volume 1, Case 18
Loren G. Yamamoto, MD, MPH
Loren G. Yamamoto, MD, MPH
Stanley M.K. Chung, MD
Stanley M.K. Chung, MD
Alson
Alson
S.
S.
Inaba
Inaba
, MD
, MD
Kapiolani
Kapiolani
Medical Center For Women And Children
Medical Center For Women And Children
University of Hawaii John A. Burns School of Medicine
University of Hawaii John A. Burns School of Medicine


/> />ris.htm
Salter
Salter
-
-
Harris Fracture Classification
Harris Fracture Classification
Jonathan
Jonathan

Cluett
Cluett
, MD
, MD


eMedicine
eMedicine
–
–
Salter
Salter
-
-
Harris Fractures : Article by William Moore, MD
Harris Fractures : Article by William Moore, MD