In this lecture, we’ll review
pediatric bone fractures
and in particular, some issues
that children have to deal with
that you don’t see
so much in adults.
So let’s remember what’s unique in
bones about children,
Here you can see a classic and this is
a normal X-ray of a child’s leg.
And you can see that there’s a metaphysis,
a growth plate or the physis,
and then the epiphysis.
Remember, the growth occurs at the
physis and is going backwards
up into the metaphysis as
it’s laying down new bone.
And the epiphysis is sort
of going along for the ride
until the growing is done and
then it all grows together.
What can happen?
Kids can have fractures
through their growth plate,
which are at increased risk for
developing growth problems.
We call these Salter-Harris fractures.
There are five types of
and they can be easily remembered
by the mnemonic SALTR,
S-A-L-T-R, you got
to drop the E.
The only thing you have
to do with this mnemonic
is draw the bones in the
which is growing down like I
showed you in that X-ray.
Let’s go through the five types
of Salter-Harris fractures.
Type 1 is slipped.
The S stands for slipped.
This is where the fracture occurs
only through the growth plate.
You can’t see this on X-ray unless
it’s really moved a long way.
An example where you might see
it moved a long way is a SCFE
or slipped capital
and there’s another talk you
can see here about that in.
In this case, sometimes, it’s only
expressed by pain over a growth plate.
So in a child, pain over a
growth plate after an injury
is a Salter-Harris 1 fracture
until proven otherwise.
This is where it goes above the
epiphysis and then through it.
This you’ll see on the X-ray as a lesion
above the area where the physis happened.
Now, this is why you have
to draw out this way
to figure out the other way
types 2 and 3 get reversed.
Because the L stands for lower.
This is where it’s
below the physis.
And then through is type four where it
goes through both the above and below.
In other words, type 2 is a
fracture through the metaphysis,
type 3 is a fracture
through the epiphysis,
and type 4 is a fracture through both
the metaphysis and the epiphysis.
What’s type 5?
That’s where it’s all
really thoroughly damaged.
The R can stand for rammed.
It’s where the whole end
is sort of destroyed.
This is a very severe type of fracture.
So type 1 fractures are about 5% of
fractures involving the growth plate.
They have a normal X-ray.
All we have to do is immobilize them and
have them follow with the orthopedics.
They may repeat the X-ray
or examine the joint
and decide whether this was a Salter 1.
Complications are very rare.
Kids do great.
Type 2 is the majority, that’s about 75%
of fractures involving the growth plate.
Generally, what we’ll
do is we’ll immobilize.
We’ll follow up with orthopedics and
again complications are very rare.
Generally, the growth is preserved.
This is an example of a Salter-Harris
2 fracture of the finger.
Don’t be confused, it’s above
and then through the physis
and you can see that finger has
become a little bit
altered in terms of it’s
orientation as well.
So here’s a type three fracture.
This is 10% of fractures
involving the growth plate.
Remember this is going through the
physis and then out the epiphysis.
This requires an immediate
It may result in chronic disability
because it crosses the physis
into the articular
surface of the bone.
Generally, these have a
They’re unlikely to cause
deformation or problems with growth
but this needs to be attended
to by an orthopedic specialist.
A type four is again about 10% of
fractures involving the growth plate.
This requires also immediate
for essentially the same reason, that
break into the articular surface.
And here, deformity of
the joint is more likely
as a long-term consequence than in type 3.
And last, type 5 fractures are very rare.
They’re usually from very severe trauma,
which requires an immediate
and their prognosis is poor for
growth and function of the joint.
So these children can
really be in trouble.