Salter Harris

Definition

 

Buckle or Torus fracture

- metaphyseal-diaphyseal junction

- compression fracture

- compression side has undergone plastic deformation

 

Greenstick Fracture

- diaphyseal injury

- failure tension side

- plastic deformity compression side

 

Greenstick Fracture APGreenstick Fracture Lateral

 

Plastic Deformity

- microscopic failure

- forearm and fibula

 

Ossification

 

Primary ossification centres

- diaphyseal

 

Secondary ossification centres

- epiphyseal

 

Physeal Anatomy

 

Reserve Zone

- few cells, high matrix

- cells from Groove of Ranvier

- cells quiescent

 

Proliferative Zone

- cellular proliferation / mitosis

- columns of cells

- longitudinal growth

- metaphyseal side

 

Hypertrophic zone

 

A.  Maturation

- enlarged, swollen, vacuolated

 

B.  Degeneration

- increase Alk Phos

- increases phosphate for calcification

 

C. Provisional calcification

- ECM calcify

- cell death

 

Perichondral Ring of La Croix & Groove of Ranvier

 

Surround the physis circumferentially at its periphery

 

Groove - resting and proliferating cells

 

Ring - cartilage cells that move towards the metaphysis and become contigous with periosteum

 

Salter Harris Classification

 

Salter Harris Classification

 

I.  Whole epiphysis is separated from shaft

 

II. Fracture through metaphysis and physis

 

III. Separation of part of the  epiphysis

- fracture through physis and epiphysis

 

IV. Fracture passes vertically through epiphysis / physis / metaphysis

 

Salter Harris IV Toe

 

V. Crushing of part or all of the epiphysis

 

Physeal fractures

 

Thought to occur primarily through hypertrophic zone

 

Reserve zone injury

- increased growth arrest with proximal tibia and distal femur

- because of undulating course of physis

- more likely damage to germinal or resting layers

 

Management

 

Do not remanipulate physeal injuries > 7-10 days

- risk injury

- exception type 3/4 

- in these anatomical reduction more important

 

Metaphyseal / diaphyseal

- can MUA up to 3 weeks after