Volume 1, Case
18
Salter-Harris
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 18
Loren G. Yamamoto, MD, MPH
Stanley M.K. Chung, MD
Alson S. Inaba, MD
If you have difficulty referencing
the Salter-Harris classification of fractures through the physis, remember
the mnemonic "ME".
Hey you !! Who ME? Yeah, you,
what kind of Salter-Harris fracture is that? ME stands for Metaphysis
and Epiphysis. The SH-I fracture, we all know is through the physis without
any involvement of the metaphysis or epiphysis. The SH-II fracture is
through the metaphysis (M) and the physis. The SH-III fracture is through
the epiphysis (E) and the physis. The SH-IV fracture is a contiguous fracture
through the epiphysis, the physis, and the metaphysis (ME). The SH-V fracture
is a crush injury of the physis.
See diagram of the SH classes.
Diagram
Click
here for a better picture
An SH-I fracture may be suspected
on clinical grounds alone. The fracture line may not be radiographically
evident if the epiphysis is not displaced. Tenderness over the physis
should lead you to suspect an occult SH-I fracture in the region of the
tenderness even if the radiographs are normal. This commonly occurs in
a wrist injury where normal wrist radiographs may lead one to the pitfall
of diagnosing a wrist sprain. If there is tenderness over the physis of
the distal radius or ulna, a clinical diagnosis of an SH-I fracture of
this area should be made. An SH-I fracture is only visible radiographically
if the physis is widened, distorted, or the epiphysis is displaced.
Radiographic confirmation
of clinical SH-I fractures may be made later during orthopedic follow-up
by stress views or the presence of new bone formation along the physis
approximately 7-10 days post-injury.
See SH-I example.
SH-I
Click
here for a better picture
What is your Diagnosis?
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here for Case 18 Answers
Loren Yamamoto,
MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns
School of Medicine loreny@hawaii.edu
Medical
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