What is Salter-Harris Fracture?
Salter-Harris fractures, also known as physeal fractures, are a type of bone breaks that occur in the growth plate (physis) and are specific to children. Doctors use a classification system to evaluate these fractures. This system assesses the involvement of different parts of the bone, such as the physis (growth plate), the metaphysis (thick part of the bone), and the epiphysis (end part of the bone). This classification is significant as it helps doctors determine the expected outcome and the best treatment plan. Moreover, it also aids in clear communication between healthcare providers.
What Causes Salter-Harris Fracture?
These types of injuries usually happen during a child’s growth spurt, when the growth plates are at their weakest. Active kids are more likely to injure their growth plates because the tissues and joints surrounding these growth plates are generally stronger and more stable. These structures can withstand more pressure or strain compared to the growth plates themselves. Once the growth plates have finished developing and fuse together, injuries to the tendons and tissues become more common, as do fractures close to the end of the bone.
Risk Factors and Frequency for Salter-Harris Fracture
The physis, also known as the growth plate, is a soft piece of cartilage found in developing bones in children. This growth plate seals at different ages in children. Physeal injuries frequently happen in children, accounting for 15% to 30% of all bone injuries. Salter-Harris fractures, a specific type of physeal injury, only occur in children and are not seen in mature adult bones.
Injuries to the upper body are more typical than those to the lower body. Among the five most common types of Salter-Harris fractures, type II is the most frequent, accounting for 75% of cases. This is followed by types III and IV, each with 10% of instances, type I at 5%, and lastly, type V, which is extremely rare and typically diagnosed after the fact.
- Boys are more prone to these fractures, likely due to their greater involvement in high-risk activities.
- Girls typically experience these fractures at a younger age of 11 to 12 years old.
- Boys are most commonly affected between the ages of 12 to 14 years old.
Signs and Symptoms of Salter-Harris Fracture
Salter-Harris fractures often occur due to trauma like collisions, crushing injuries or falls. The symptoms usually involve pain in the joint, swelling around the area, and sensitivity over the growth plate. If the fracture occurs in an arm, movement may be restricted. If it’s in a leg, the person might not be able to put weight on it. Sometimes, these symptoms can seem like a ligament injury. So, tests for ligament looseness may give positive results. But, it’s important not to mistakenly think that symptoms are only due to issues in the joint tissues.
Testing for Salter-Harris Fracture
Salter-Harris fractures are a type of bone fracture that can affect the growth plate in children and adolescents. These fractures are classified into different types, from type I to V, depending on their severity. Lower numbers are less severe and have a lower chance of affecting growth. However, higher numbers indicate more severe fractures and have a higher likelihood of disrupting normal growth.
Type I Salter-Harris fractures occur within the growth plate. While a normal X-ray may not always show this type of fracture, symptoms such as swelling or tenderness around the growth plate can indicate its presence.
Type II fractures occur in the growth plate and also extend into the part of the bone called the metaphysis. These are the most common type and often occur away from the joint.
Type III fractures extend from the growth plate into the epiphysis, the end of the bone. Since these fractures involve the part of the bone that contributes to joint surfaces, they can damage the adjoining cartilage, which helps joints move smoothly.
Type IV fractures go all the way through the bone, passing through the epiphysis, the growth plate, and the metaphysis. This type of fracture also damages the joint surfaces.
Type V fractures involve a crush or compression injury to the growth plate. This type of fracture may not be immediately apparent on an X-ray, and it may only be identified once it has interfered with normal bone growth. It can result from severe injuries like electric shock, frostbite, or radiation exposure and can lead to significant disruption in bone growth.
If an X-ray doesn’t clearly show the fracture, a CT scan or MRI may be used to get more detail. These tools can be especially useful to verify a fracture’s extent or involvement with the joint surfaces. The key concern with these fractures is that they can disrupt normal growth, leading to deformity or differences in limb length. An urgent evaluation by an orthopedic specialist is needed if a type III or IV fracture is suspected.
Treatment Options for Salter-Harris Fracture
Salter-Harris I and II fractures are typically managed with non-invasive methods like re-positioning the broken bone without surgery, casting, or using a splint. This treatment must be carried out gently to avoid further harm to the growth plate or causing friction on any broken pieces of bone in the area surrounding the growth plate.
Salter-Harris III and IV fractures generally require more invasive treatment. They often need surgery to reposition the bone and the use of internal supports to hold the bone in place. While performing these treatments, it is crucial not to disturb the growth plate.
Salter-Harris V fractures are tricky. They can often go undetected unless doctors specifically look for them. This type of fracture affects the part of the bone where new bone cells are produced, so it may potentially halt growth. If detected, immediate consultation with a bone specialist is necessary.
Irrespective of the type, patients with Salter-Harris fractures must have a follow-up examination within seven to ten days. These check-ups are crucial for monitoring the healing process. They also help spot complications such as halted growth early on. If needed, follow-up X-rays may be taken at six months and a year after the injury to check for signs of halted growth.
There are certain complications associated with Salter-Harris fractures. The most significant one is the halting of growth, which can lead to deformities and differences in limb lengths. A lesser-known complication is the getting stuck of the thin layer of tissue that covers the bone (periosteum) within the fracture. This is rare but can prevent the complete healing of the fracture. An MRI scan is usually called for in this case. This scanning technique can provide detailed images of the fracture and check for trapped periosteum.
What else can Salter-Harris Fracture be?
Even though x-rays may not always clearly show fractures, it is critical for doctors to stay alert and use their examination skills to spot these injuries. Sometimes, muscle sprains and tendon injuries can be the focus if fractures are not visible on x-ray images.
What to expect with Salter-Harris Fracture
Generally, the quicker these fractures are detected, the better the overall outlook, as long as they’re treated right away. Whether the treatment involves regular monitoring and pain relief, or an evaluation by an orthopedic specialist and surgery, patients tend to recover well in the long run after receiving treatment for fractures.
Possible Complications When Diagnosed with Salter-Harris Fracture
If a Salter-Harris fracture (a type of bone break in children) isn’t picked up and treated on time, a bunch of complications can occur. These can significantly affect the child’s life. The two main complications are additional injuries and hindrances to their growth. It’s also important to note that delayed treatment can cause ongoing pain and limit the child’s ability to move around.
Common Complications:
- Further injury
- Growth restriction
- Prolonged pain
- Mobility restriction
Preventing Salter-Harris Fracture
The aftercare for injuries like Salter-Harris fractures is pretty standard. It’s important that the injured joint is rested, elevated, and any pain is managed properly. When patients come back for check-ups weeks or even years after the initial injury and treatment, it’s critical to conduct a thorough physical exam. This includes testing the strength of the injured area, checking for any differences in limb length, and assessing the range of motion.
