Hashmi, R

Masroor, I

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eCommons@AKUDepartment of Radiology Medical College, PakistanJuly 2002View box case--7 Salter-Harris type-II fractureI MasroorAga Khan University, imrana.masroor@aku.eduR HashmiFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationMasroor, I., Hashmi, R. (2002). View box case--7 Salter-Harris type-II fracture. Journal of Pakistan Medical Association, 52(7), 329-330.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/294View Box Case - 7I. Masroor,R. Hashmi  ( Radiology Department, Aga Khan University Hospital, Karachi. ) A 15 year old boy presented with severe pain and swelling of left knee following a fall from secondfloor. Xray examination of left knee showed fracture of epiphysial plate of left femur with a chip ofmetaphysis and posterior and lateral displacement of epiphysis (Figure 1, 2).Diagnosis: Salter-Harris Type-II fracture.Discussion Because of the unique anatomy and physiology associated with the growth plate complex, an injury tothe juxtaarticular region in a child has a significantly different diagnostic and prognostic implicationthan would a similar trauma in an adult. Injuries to the growth plate are present in almost one sixth ofall childhood fractures. As would be expected, as the child becomes more mobile and athletic theincidence of this type of injury will increase and the more violent life led by most boys will be reflectedin a relatively increased number of these injuries in males.Initial examination should have at least two radiographic projections, preferably oriented at right anglesto each other. Although cartilage is not distinct from other soft tissues on plain films, the fat planes areusually well identified in children and can often be used to defme capsular and cartilage boundaries.Comparison films of the opposite side should be confined to situations in which the diagnosis is notclear, most commonly when the anatomical area is complex or normal variants are frequent. If minimalgrowth plate widening or epiphysis shift is suspected, a comparison film of the opposite side may bequite helpful, but the routine use of such in all clinical situations is of doubtful utility.Many classifications of growth plate injury have been formulated. That described by Salter and Harris1is most commonly used clinically. (Figure 3).Type I fractures involve the growth plate only, without visible fracture line in either epiphysis ormetaphysis. These injuries comprise about 6% of all growth plate injuries and are usually encounteredin younger children, except in the proximal humerus and proximal femur, where the preadolescentchild is more commonly affected.The prognosis for full recovery after a type I slip is quite good because only the growth plate isaffected. It should be noted, however, that if anatomical reduction is not accomplished, resumption ofgrowth in a displaced position will soon take place and malalignment may follow.A Type II injury is by far the most commonly seen, occurring in one half to three quarters of all growthplate injuries. It is most common in the prepubertal child and adolescent, involving the distal radius,distal tibia, and distal fibula, in that order. It involves the growth plate and metaphysis. A prominentmetaphysial corner fragment displaced to the same degree as the epiphysis, is the hallmark of thisinjury. Again, the prognosis for complete restoration of function is quite good.Type Ill injuries are slightly more common than type 1. They usually occur in older children in whom aportion of the growth plate has fused. The sharing force passes through the nominated portion of thegrowth plate and then deviates at a right angle to the growth plate while passing through the epiphysis.The distal and proximal tibia are the most common sites of involvement. In comparison with types II,and I the prognosis in type III injury is not as good.Type IV injuries comprise about 10% of all trauma to the growth complex. The distal humerus anddistal tibia are the areas most commonly involved. The growth plate, metaphysis and epiphysis are allaffected. The prognosis in this type of injury is quite guarded. Even with complete reduction of thefracture fragment, the violence done to the functional area of the growth plate may be sufficient that nofurther growth will take place in this area. Early diagnosis and treatment of growth disturbance canprevent severe deformity2.Type V fracture is quite uncommon, being seen in fewer then 1% of growth complex injuries involvesonly a crush of the growth plate without visible fracture line. The diagnosis cannot be made withcertainly initially. Most of these injuries take place at the knee or ankle.Type VI injuries are extremely uncommon. Injury to the perichondrium peripheral to the growth mayoccur as a result of direct trauma, adjacent soft-tissue infection, or thermal injury. The trauma acts as astimulus to bone formation in the perichondrium.In type Vii injury, only the epiphysis is affected and not the growth plate itself, if the fracture lineinvolves only cartilage, detection by routine radiography is impossible without arthography or MRI.MR imaging detects abnormalities in the cartilage that are associated with growth disturbances andprovides accurate mapping of physeal injuries3. If the fracture line passes through a portion of theossified epiphysis, however, it will be detected as a bone fragment separated from the main body of theossification center. If some time has passed after the injury, resumption of this fragment may occur andthe only evidence of the trauma will be a small defect in the ossification canter. Many of thetranschondral injuries included in type VII are known characteristically by synonyms or eponyms,these include osteochondritis dissecans, Osgood-Schiatter disease etc.In the immediate evaluation of all growth plate complex trauma, the aim of initial diagnosis should beto classify the lesion as appropriately as possible, because this will influence both initial treatment andsubsequent prognosis.Although appropriate treatment can prevent or ameliorate most of the complications resulting frominjury to the growth plate, some are inevitable, given the violence applied to this zone. Latecomplications include decreased growth rate, cessation of growth, ischemic necrosis etc.References 1.Brown JH, Deluca SA. Growth plate injuries: Salter.Harris classification. Am. Fam. Physician.. 1992;46:1180-84.2.Berson L, Davidson RS, Dormans JP, Growth disturbances after distal tibial physeal fractures. FootAnkle Int., 2000; 21:54.8.3.Jaramillo D. Hoffer FA, Shapiro F. MR imaging of fractures of growth plate. AJR.. 1990; 155: 1261-65.

View box case--7 Salter-Harris type-II fracture

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View box case--7 Salter-Harris type-II fracture

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