Salter-Harris Fractures

Overview

A Salter-Harris fracture is a break in the soft area of cartilage at the ends of long bones in children. This area is called a growth plate or an epiphyseal plate. Salter-Harris fractures can occur in any bone that is longer than it is wide, including fingers, toes, arms, and legs. Children’s bone growth occurs mainly in the growth plates, so they are not yet solid bone. This unique fracture was identified by Canadian doctors Robert Salter and W. Robert Harris in the 1960s.

Causes and Symptoms

Being relatively weak, growth plates can be injured when excessive pressure is applied or a child falls or collides with something. Salter-Harris fractures account for 15 to 30 percent of all bone injuries in children and they commonly occur during sporting activity. Boys are twice as likely as girls to suffer a Salter-Harris fracture.

Pain after a fall is a key symptom along with tenderness and a limited range of motion in the area. If a lower limb is affected, the child may also be unable to bear weight on it. Other things to look out for are swelling and warmth around the joint and bone displacement or deformity.

Types of Salter-Harris Fractures

Salter-Harris fractures

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Salter-Harris fractures usually fall into five main categories which correspond with the way the injury impacts the growth plate and surrounding bone. The higher the number, the higher the risk of possible bone growth problems.

Type 1 fractures are more common in younger children and account for about only five percent of Salter-Harris fractures. They occur when a force separates the rounded edge of the bone from the bone shaft.

Type 2 fractures are the most common, occurring when the growth plate is hit, and it splits away from the joint taking a small piece of the bone shaft. These account for 75 percent of Salter-Harris fractures and they happen most often in children over ten.

Type 3 breaks occur when a force hits the growth plate and the rounded part of the bone, but not the bone shaft. The fracture may include the cartilage and joint.

Salter-Harris fractures

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Type 4 fractures include the growth plate, the rounded part of the bone, and the bone shaft. This type of fracture can occur at any age and it can have an effect on the child’s bone growth.

Type 5 fractures are uncommon and typically involve the knee and ankle. In this case, the growth plate is crushed or compressed.

There are four other types of Salter-Harris fracture but they are extremely rare. Types 6 and 7 affect the connective tissue and bone end, respectively. Types 8 and 9 affect the bone shaft and fibrous membrane of the bone, respectively.

Diagnosis and Treatment

It is important for growth plate fractures to be treated in a timely manner. A doctor will typically ask questions about how the injury occurred and whether the child has broken any bones before. They will most likely ask for x-rays to be performed on the injured area. More complex fractures may call for CT scans or MRIs. Ultrasounds may also be used for infants.

Treatment of Salter-Harris fractures can be non-surgical or surgical, depending on the bone involved and the severity of the injury. Types 1 and 2 are usually treated with a cast, splint or sling. Sometimes the bones may be realigned in what is called a closed reduction. Type 5 fractures are difficult to diagnose.  The doctor may suggest keeping weight off the bone and monitoring how growth progresses before starting treatment.

Salter-Harris fractures

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Types 3 and 4 Salter-Harris fractures are typically realigned surgically in an open reduction.  The surgeon will align the bone fragments and hold them in place with screws, wires or metal plates. Some Type 5 fractures may also be treated this way. A cast is then applied to protect the area while it heals.

Recovery

Salter-Harris fractures often heal in four to six weeks, but recovery times vary. After a period of immobilization, the doctor may recommend physical therapy to help the child regain use of the area.

Moving the injured area normally or taking part in sporting activities may take some additional time. Children who suffer fractures are often advised to wait four to six months before playing contact sports.