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Case of the Week 241

What's the most likely diagnosis?

  • 10 year-old with pain in ankle after fall

  1. Salter-Harris I fracture
  2. Salter-Harris II fracture
  3. Salter-Harris III fracture
  4. Salter-Harris IV fracture
  5. Salter-Harris V fracture



4. Salter-Harris IV fracture



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Salter-Harris Fractures

  • General Considerations
    • The epiphyseal pclate (physis or growth plate) is the weakest part of the bone to shearing injuries
    • The Salter-Harris classification is a means of categorizing epiphyseal plate fractures and provides clues to their prognosis
    • All such fractures, by definition, involve or extend through the epiphyseal plate so that all such fractures occur in children before the epiphyseal plate closes
  • Salter-Harris I Fractures
    • Occurs through the hypertrophic zone of the epiphyseal plate
    • Only the epiphyseal plate is fractured
    • Rarely produces complications
    • May be difficult to diagnose unless there is visible displacement of the epiphysis on the metaphysis
    • Slipped capital femoral epiphysis (SCFE) is an example of a Salter-Harris I fracture
  • Salter-Harris II Fractures
    • Most common Salter-Harris fracture -85%
    • Involves both the epiphyseal plate and the metaphysis
    • Small corner of metaphysis that is usually fractured produces the “corner sign”
    • Rarely produces complications


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