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Salter-Harris fractures (physeal fractures) refer to fractures through a growth plate (physis) and are therefore specifically applied to bone fractures in children. The commonest injuries seen in children with open growth plates are fractures involving epiphyseal plates, or physis
Salter-Harris fractures are unique to children because they involve the growth plate.
The bones of growing children contain four sections including the diaphysis (shaft), metaphysis, and epiphysis (end). The metaphysis and epiphysis are separated by the physis (growth plate)(1).
What is a growth plate?
The growth plate is the area of tissue near the ends of long bones in children and teens that determines the future length and shape of the mature bone.
Each long bone has at least two growth plates, one at each end, and they are longer than they are wide. For example, the femur (thigh bone), radius and ulna (forearm), and the metacarpal bones (hands and fingers) are long bones.
Once your child’s growth is complete – sometime during adolescence – the growth plates close and are replaced by solid bone.
The growth plates are weak areas of your child’s growing skeleton. Because they are even weaker than the nearby ligaments and tendons that connect bones to other bones and muscles, growth plates are vulnerable to injury.
Injuries to the growth plate (fractures) can result from a single traumatic event, such as a fall or automobile accident, or from chronic stress and overuse(2).
Mechanism of injury
Salter-Harris fractures are often the result of sports-related injuries however they have also been attributed to child abuse, genetics, injury from extreme cold, radiation and medications, neurological disorders, and metabolic diseases which all affect the growth plate according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Approximately 1/3rd of Salter-Harris fractures occur as the result of sports and 1/5th occur from recreational activities. They may result from a single injury or may be caused by repetitive stresses on the upper and lower extremities(1).
The Salter-Harris classification system is a method used to grade fractures that occur in children and involve the growth plate, which is also known as the physis or physeal plate. The classification system grades fractures according to the involvement of the physis, metaphysis, and epiphysis
There are 5 major classifications.
Type I is a fracture through the growth plate.
Type II extends through the metaphysis and the growth plate(1).
Type III This is an intra-articular fracture extending from the physis into the epiphysis. If the fracture extends the complete length of the physis, this type of fracture may form two epiphyseal segments. Since the epiphysis is involved, damage to the articular cartilage may occur. One example is a Tillaux fracture of the ankle, which is a fracture of the anterolateral aspect of the growth plate and epiphysis.
IV extends through the epiphysis, the growth plate and the metaphysis.
Type V is a crushing type or compression injury of the growth plate injury that affects the growth plate(1).
Symptoms of a growth plate injury includes:
Persistent pain and tenderness after a sudden or overuse injury.
Deformity, warmth, or swelling at the end of a bone.
Changes in how your child bends their limb.
Inability to move, put pressure on, or bear weight on a limb because of pain.
Point tenderness on palpation at the epiphyseal plate may indicate a fracture.
Other signs to look for are persistent pain or pain that affects the child’s ability to tolerate weight bearing through the limb or use of the limb. Soft tissue swelling and/or visible deformity could be another sign of a fracture(2)
With proper treatment, most growth plate fractures heal without any lasting effect and can prevent problems with bone growth(2).
According to information from NIAMS:
Type I and most Type II fractures are treated with cast immobilization with closed reduction and casting or splinting. The reduction should be performed carefully to avoid damage to or grating of the physis on any metaphyseal bone fragments.
Although Type II sometimes requires surgery. Both normally heal well.
Type III disrupts the growth plate and therefore requires surgery. Internal fixation may be required to allow for good alignment. Open reduction and internal fixation (avoiding crossing the physis).
Type III and IV fractures with displacement of less than 2mm may also be managed non-surgically with a period of non-weight bearing in a cast followed by a period of non-weight bearing in a fracture boot.
Type IV and Type V are also usually treated with surgery with internal fixation(1).
Physical Therapy Management
Resting the injured joint with elevation and pain control is essential(3).
Physical therapy will help in restoring range of motion, strength, and function.
In the acute phase after injury or surgical management, physical therapy focuses on assisting the patient with adherends to immobilization or weight-bearing protocols.
Controlled range of motion exercises and light strengthening can be implemented.
After the growth plate has undergone sufficient healing, progressive strengthening, range of motion, balance, and proprioception; exercises should be implemented.
In young athletes, advanced rehabilitation should include sport-specific exercises and drills(1)
The fracture grade has important implications for both prognosis and treatment. Most of these injuries occur during a child's growth spurt when growth plates are the weakest.
Active children are the most likely to encounter injuries involving the growth plate as the ligaments and joint capsules surrounding the growth plate tend to be much stronger and more stable
Physical therapists play a crucial role with the interprofessional team and must keep other team members apprised of the patient's progress or lack thereof, so appropriate therapy changes can be implemented if necessary(3).
At Valley Healing Hands, we provide the best Physical Therapy treatment for Salter Harris Fracture. We provide an atmosphere developed for teen athletes with a one on one ratio for the best quality of care needed for maximum outcomes and return to play. Our physical therapist are highly qualified and will plan an individualized treatment routine, customized to the specific needs of our patients. We are happy to let you know that our patients are highly satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will!