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[[File:Salter-Harris classification.jpg|alt=Courtesy of DrMars, <https://www.wikidoc.org>|thumb|Salter-Harris classification]]
__NOTOC__
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{{SI}}
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{{CMG}}


==Overview==
{{CMG}}; {{AE}}[[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]].
A '''Salter–Harris fracture''' is a fracture that involves the [[epiphyseal plate]] or [[growth plate]] of a bone. It is a common injury found in children, occurring in 15% of childhood long bone fractures.<ref name="sh"/>
==Overview<ref name="pmid27206505">{{cite journal |vauthors=Cepela DJ, Tartaglione JP, Dooley TP, Patel PN |title=Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures |journal=Clin. Orthop. Relat. Res. |volume=474 |issue=11 |pages=2531–2537 |date=November 2016 |pmid=27206505 |pmc=5052189 |doi=10.1007/s11999-016-4891-3 |url=}}</ref>==
 
Injuries leading to the bone fracture affecting the epiphyseal plate, or physis, are important and common in orthopedic medicine and the cause diagnostic and treatment challenges for orthopaedic surgeons. The related incidence rate of these fracture among pedicatric population is 15-20%.
 
== Historical Perspective <ref name="pmid9150026">{{cite journal |vauthors=Loder RT, Swinford AE, Kuhns LR |title=The use of helical computed tomographic scan to assess bony physeal bridges |journal=J Pediatr Orthop |volume=17 |issue=3 |pages=356–9 |date=1997 |pmid=9150026 |doi= |url=}}</ref><ref name="pmid19461377">{{cite journal |vauthors=Leary JT, Handling M, Talerico M, Yong L, Bowe JA |title=Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest |journal=J Pediatr Orthop |volume=29 |issue=4 |pages=356–61 |date=June 2009 |pmid=19461377 |doi=10.1097/BPO.0b013e3181a6bfe8 |url=}}</ref><ref name="pmid16670543">{{cite journal |vauthors=Rohmiller MT, Gaynor TP, Pawelek J, Mubarak SJ |title=Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure? |journal=J Pediatr Orthop |volume=26 |issue=3 |pages=322–8 |date=2006 |pmid=16670543 |doi=10.1097/01.bpo.0000217714.80233.0b |url=}}</ref><ref name="pmid20563820">{{cite journal |vauthors=Lemburg SP, Lilienthal E, Heyer CM |title=Growth plate fractures of the distal tibia: is CT imaging necessary? |journal=Arch Orthop Trauma Surg |volume=130 |issue=11 |pages=1411–7 |date=November 2010 |pmid=20563820 |doi=10.1007/s00402-010-1140-1 |url=}}</ref>==
In 1863, Foucher JT was the first person who described the injuries affecting the epiphyseal plate.


==Types==
In 1895, Poland J, classified the injuries affecting the epiphyseal plat into the four types.
There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963,<ref name="sh">{{cite journal |coauthors=Salter RB, Harris WR |year=1963 |title=Injuries Involving the Epiphyseal Plate |journal=J Bone Joint Surg Am. |volume=45 |issue=3 |pages=587–622 |pmc= |url=http://www.ejbjs.org/cgi/reprint/45/3/587 |accessdate=2010-10-12}}</ref> and the rarer types VI to IX which have been added subsequently:<ref>{{EMedicine|article|412956|Salter-Harris Fracture Imaging}}</ref>
* Type I – A transverse fracture through the [[growth plate]] (also referred to as the "[[physis]]"):<ref>[http://www.wheelessonline.com/ortho/sh_type_i S.H. Type I – Wheeless' Textbook of Orthopaedics<!-- Bot generated title -->]</ref> 6% incidence
* Type II – A fracture through the growth plate and the [[metaphysis]], sparing the [[epiphysis]]:<ref>[http://www.wheelessonline.com/ortho/sh_type_ii S.H. Type II – Wheeless' Textbook of Orthopaedics<!-- Bot generated title -->]</ref> 75% incidence, takes approximately 2–3 weeks to heal.
* Type III – A fracture through [[growth plate]] and [[epiphysis]], sparing the [[metaphysis]]:<ref>[http://www.wheelessonline.com/ortho/salter_harris_type_iii_frx Salter Harris Type III Frx – Wheeless' Textbook of Orthopaedics<!-- Bot generated title -->]</ref> 8% incidence
* Type IV – A fracture through all three elements of the bone, the [[growth plate]], [[metaphysis]], and [[epiphysis]]:<ref>[http://www.wheelessonline.com/ortho/salter_harris_type_iv Salter Harris: Type IV – Wheeless' Textbook of Orthopaedics<!-- Bot generated title -->]</ref> 10% incidence
* Type V – A compression fracture of the [[growth plate]] (resulting in a decrease in the perceived space between the [[epiphysis]] and [[diaphysis]] on x-ray):<ref>[http://www.wheelessonline.com/ortho/type_v Type V – Wheeless' Textbook of Orthopaedics<!-- Bot generated title -->]</ref> 1% incidence
* Type VI – Injury to the peripheral portion of the [[physis]] and a resultant bony bridge formation which may produce an angular deformity (added in 1969 by Mercer Rang)<ref>{{cite book |title= The Growth Plate and Its Disorders |editor1-first=Mercer |editor1-last=Rang |year=1968 |publisher=Harcourt Brace/Churchill Livingstone |isbn=978-0-443-00568-8}}</ref>
* Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)<ref>{{cite journal |author=JA Ogden |year=1982 |title=Skeletal growth mechanism injury patterns |journal=J Pediatr Orthop |volume=2 |issue=4 |pages=371–377 |pmid=7142386 |accessdate=2010-10-12}}</ref>
* Type VIII – Isolated injury of the metaphysis with possible impairment of [[endochondral ossification]]
* Type IX – Injury of the periosteum which may impair [[intramembranous ossification]]


==SALTER mnemonic for classification==
In 1936 , Aitken AP, defined the specific differences of different types of physes based on their differences in: structure, location, weightbearing status, and susceptibility to injury.
The mnemonic "SALTR" can be used to help remember the first five types.<ref name=Davis>{{cite book |title=Blueprints Radiology|url=http://books.google.com.au/books?hl=en&lr=&id=coLSTFjlGqcC&oi=fnd&pg=PA12&dq=salter+harris+classification+SALTR&ots=WVQ-ieWDQQ&sig=qd2c4R78GMvcGqvLTa__G1oitQA#PPA83,M1 |first=Ryan|last=Davis|accessdate=2008-03-03}}</ref><ref name=Gaillard>{{cite web |title=Radiopedia|url=http://www.radiopaedia.org/index.php?title=SALTR |first=Frank|last=Gaillard|accessdate=2008-03-03}} {{Dead link|date=October 2010|bot=H3llBot}}</ref><ref name=Tidey>{{cite web |title=Salter-Harris Fractures|url=http://members.fortunecity.com/radrep/id36.htm |first=Brian|last=Tidey|accessdate=2008-03-03}}</ref>  This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.


* I  – S = '''Slip (separated or straight across)'''. Fracture of the cartilage of the physis (growth plate)
In 1963, two Canadian orthopaedic surgeons, Robert B. Salter (1924–2010) and W. Robert Harris (1922–2005), introduced a physeal fracture classification system according to the anatomy, fracture pattern, and prognosis of bone fracture.
* II  – A = '''Above'''. The fracture lies above the physis, or '''A'''way from the joint.
* III – L = '''Lower'''. The fracture is below the physis in the epiphysis.
* IV  – T = '''Through'''. The fracture is through the metaphysis, physis, and epiphysis.
* V  – R = '''Rammed (crushed)'''. The physis has been crushed.


(alternatively SALTER can be used for the first 6 types - as above but adding Type V: 'E' for Everything or Epiphysis and Type VI:'R' for Ring)
Then, various researchers and physicians tried to expanded the original work of Salter and Harris in order to make it to be to be more comprehensive:


==References==
In 1968, Rang M, added a different sixth type of physeal injuries describing the caused damage to the perichondral ring due to the direct open injuries to the affected bone.
{{reflist|colwidth=30em}}
 
In 1981, Ogden JA, described nine types of injuries such as injuries affecting the developing bone’s other growth mechanisms.
 
==Salter-Harris classification==
{| class="wikitable"
|+
!Type
!Descrpstion
!Image
!Radiography
|-
|Normal
|
|[[File:Normal Bone.jpg|alt=courtesy of DrMars, <https://www.wikidoc.org>|thumb|'''''Normal Bone''''']]
|
|-
|Type I
|
* Frequency: 5-7%
* cannot occur if the growth plate is fused cit
* good prognosis
* Mechanism: Fractured plane involved  the whole growth plate, not involving bone
* Origin: through the growth plate
|[[File:Type1-Salter-Harris classification.jpg|alt=courtesy of DrMars, <https://www.wikidoc.org>|thumb|'''''Type 1-Salter-Harris classification''''']]
|[[File:Salter-Harris type I injury of shoulder.jpg|thumb|'''Salter-Harris type I injury of shoulder''']]
|-
|Type II
|
* Frequency: 75%
* good prognosis
* Mechanism: Fractured plane involved most of the growth plate and up through the metaphysis
* Origin: through the growth plate and the metaphysis, sparing the epiphysis
|[[File:Type 2 Salter-Harris classification.jpg|alt=courtesy of DrMars, <https://www.wikidoc.org>|thumb|'''''Type 2 Salter-Harris classification''''']]
|[[File:Salter-Harris type II injury of ankle.jpg|thumb|'''Salter-Harris type II injury of ankle''']]
|-
|Type III
|
* Frequency: 7-10%
* cannot occur if the growth plate is fused cit
* poorer prognosis as the proliferative and reserve zones are interrupted
* Mechanism: Fractured plane involved the growth plate through the epiphysis
* Origin: through growth plate and epiphysis, sparing the metaphysis
|[[File:Type 3 Salter-Harris classification.jpg|alt=courtesy of DrMars, <https://www.wikidoc.org>|thumb|'''''Type 3 Salter-Harris classification''''']]
|[[File:Salter-Harris type III injury of ankle.jpeg|thumb|'''Salter-Harris type III injury of ankle''']]
|-
|Type IV
|
* Frequency: 10%
* cannot occur intra-articular
* poor prognosis as the proliferative and reserve zones are interrupted
* Mechanism: Fractured plane involved directly through the metaphysis, growth plate and down through the epiphysis
* Origin: through all three elements of the bone, the growth plate, metaphysis, and epiphysis
|[[File:Type 4- Salter-Harris classification.jpg|alt=courtesy of DrMars, <https://www.wikidoc.org>|thumb|'''''Type 4- Salter-Harris classification''''']]
|[[File:Salter-Harris type IV injury of foot.jpg|thumb|'''Salter-Harris type III injury of foot''']]
 
|-
|Type V
|
* Frequency: <1%
* cannot occur if the growth plate is fused cit
* worst prognosis
* Mechanism: Fractured plane dose note involved the growth plate but damages it by direct compression
* Origin: decrease in the perceived space between the epiphysis and metaphysis
|[[File:Type 5 Salter-Harris classification.jpg|alt=courtesy of DrMars, <https://www.wikidoc.org>|thumb|'''''Type 5 Salter-Harris classification''''']]
|
|-
|Rare Types: Type VI
|
* An isolated damage of the perichondral structures
|
|
|-
|Rare Types: Type VII
|
* An isolated damage of the epiphyseal plate
|
|
|-
|Rare Types: Type VIII
|
* An isolated damage of the metaphysis, with a potential injury due to the endochondral ossification
|
|
|-
|Rare Types: Type IX
|
* An isolated damage of the periosteum that may interfere with membranous growth plane
|
|
|}
==See also==
 
 
*[[Humerus fracture]]


==External links==
*[http://www.emedicine.com/orthoped/topic627.htm "Growth Plate (Physeal) Fractures" at emedicine.com]


{{Fractures}}
{{Fractures}}


{{DEFAULTSORT:Salter-Harris fracture}}
[[Category:Bone fractures]]
[[Category:Eponymous fracture classifications]]


[[de:Epiphysiolyse]]
 
[[es:Epifisiólisis]]
{{WikiDoc Sources}}
[[pt:Classificação de Salter-Harris]]
 
[[ru:Эпифизеолиз]]
==References==
<references />
 
[[Category:Fractures]]
[[Category:Injuries]]
[[Category:Traumatology]]
[[Category:Orthopedics]]
[[Category:Disease]]
[[Category:Radiology]]

Latest revision as of 00:04, 30 July 2020

Courtesy of DrMars, <https://www.wikidoc.org>
Salter-Harris classification


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

Overview[1]

Injuries leading to the bone fracture affecting the epiphyseal plate, or physis, are important and common in orthopedic medicine and the cause diagnostic and treatment challenges for orthopaedic surgeons. The related incidence rate of these fracture among pedicatric population is 15-20%.

Historical Perspective [2][3][4][5]

In 1863, Foucher JT was the first person who described the injuries affecting the epiphyseal plate.

In 1895, Poland J, classified the injuries affecting the epiphyseal plat into the four types.

In 1936 , Aitken AP, defined the specific differences of different types of physes based on their differences in: structure, location, weightbearing status, and susceptibility to injury.

In 1963, two Canadian orthopaedic surgeons, Robert B. Salter (1924–2010) and W. Robert Harris (1922–2005), introduced a physeal fracture classification system according to the anatomy, fracture pattern, and prognosis of bone fracture.

Then, various researchers and physicians tried to expanded the original work of Salter and Harris in order to make it to be to be more comprehensive:

In 1968, Rang M, added a different sixth type of physeal injuries describing the caused damage to the perichondral ring due to the direct open injuries to the affected bone.

In 1981, Ogden JA, described nine types of injuries such as injuries affecting the developing bone’s other growth mechanisms.

Salter-Harris classification

Type Descrpstion Image Radiography
Normal
courtesy of DrMars, <https://www.wikidoc.org>
Normal Bone
Type I
  • Frequency: 5-7%
  • cannot occur if the growth plate is fused cit
  • good prognosis
  • Mechanism: Fractured plane involved the whole growth plate, not involving bone
  • Origin: through the growth plate
courtesy of DrMars, <https://www.wikidoc.org>
Type 1-Salter-Harris classification
Salter-Harris type I injury of shoulder
Type II
  • Frequency: 75%
  • good prognosis
  • Mechanism: Fractured plane involved most of the growth plate and up through the metaphysis
  • Origin: through the growth plate and the metaphysis, sparing the epiphysis
courtesy of DrMars, <https://www.wikidoc.org>
Type 2 Salter-Harris classification
Salter-Harris type II injury of ankle
Type III
  • Frequency: 7-10%
  • cannot occur if the growth plate is fused cit
  • poorer prognosis as the proliferative and reserve zones are interrupted
  • Mechanism: Fractured plane involved the growth plate through the epiphysis
  • Origin: through growth plate and epiphysis, sparing the metaphysis
courtesy of DrMars, <https://www.wikidoc.org>
Type 3 Salter-Harris classification
Salter-Harris type III injury of ankle
Type IV
  • Frequency: 10%
  • cannot occur intra-articular
  • poor prognosis as the proliferative and reserve zones are interrupted
  • Mechanism: Fractured plane involved directly through the metaphysis, growth plate and down through the epiphysis
  • Origin: through all three elements of the bone, the growth plate, metaphysis, and epiphysis
courtesy of DrMars, <https://www.wikidoc.org>
Type 4- Salter-Harris classification
Salter-Harris type III injury of foot
Type V
  • Frequency: <1%
  • cannot occur if the growth plate is fused cit
  • worst prognosis
  • Mechanism: Fractured plane dose note involved the growth plate but damages it by direct compression
  • Origin: decrease in the perceived space between the epiphysis and metaphysis
courtesy of DrMars, <https://www.wikidoc.org>
Type 5 Salter-Harris classification
Rare Types: Type VI
  • An isolated damage of the perichondral structures
Rare Types: Type VII
  • An isolated damage of the epiphyseal plate
Rare Types: Type VIII
  • An isolated damage of the metaphysis, with a potential injury due to the endochondral ossification
Rare Types: Type IX
  • An isolated damage of the periosteum that may interfere with membranous growth plane

See also


Template:Fractures


Template:WikiDoc Sources

References

  1. ↑ Cepela DJ, Tartaglione JP, Dooley TP, Patel PN (November 2016). "Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures". Clin. Orthop. Relat. Res. 474 (11): 2531–2537. doi:10.1007/s11999-016-4891-3. PMC 5052189. PMID 27206505.
  2. ↑ Loder RT, Swinford AE, Kuhns LR (1997). "The use of helical computed tomographic scan to assess bony physeal bridges". J Pediatr Orthop. 17 (3): 356–9. PMID 9150026.
  3. ↑ Leary JT, Handling M, Talerico M, Yong L, Bowe JA (June 2009). "Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest". J Pediatr Orthop. 29 (4): 356–61. doi:10.1097/BPO.0b013e3181a6bfe8. PMID 19461377.
  4. ↑ Rohmiller MT, Gaynor TP, Pawelek J, Mubarak SJ (2006). "Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure?". J Pediatr Orthop. 26 (3): 322–8. doi:10.1097/01.bpo.0000217714.80233.0b. PMID 16670543.
  5. ↑ Lemburg SP, Lilienthal E, Heyer CM (November 2010). "Growth plate fractures of the distal tibia: is CT imaging necessary?". Arch Orthop Trauma Surg. 130 (11): 1411–7. doi:10.1007/s00402-010-1140-1. PMID 20563820.
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