![]() DISCUSSION: Type IV Salter Harris fracture involves all three elements of the bone and is an intra-articular fracture. FINAL DIAGNOSIS: Fracture across the metaphysis, physis and epiphysis: Salter Harris Type IV. Orthopedic Classification: Salter Harris Type IV. B) CT SCAN: The fracture line goes through the metaphysis, growth plate and down through the epiphysis. Orthopedic Classification: Salter Harris Type III. Orthopedic Classification: Salter Harris Type II and b) Lateral view: Fracture passes along the growth plate and down through the epiphysis. TESTS & RESULTS: A) Radiological evaluation: a) Posterior and anterior view: Fracture passes through most of the growth plate and up through the metaphysis. DIFFERENTIAL DIAGNOSES: Salter Harris II, Salter Harris III, Salter Harris IV, Salter Harris V, or additional fractures. Therefore, he ordered a MRI and spiral CT for the left ankle. That doctor suspected that the fracture may continue into the posterior malleolus with the fracture line going through the growth plate inside the joint of the ankle. ![]() ![]() Two days after that, the athlete decided to visit a different private doctor since the pain was not subsiding. He decided to visit a private orthopedic doctor who made the plaster rounded and placed the foot in tip-toe gait. Two days later, the patient was still in pain. Before getting discharged, a second X-Ray showed a well-aligned fracture. A short, leg cast was placed and per os analgesics were given. The diagnosis based on the first X-Ray was Type II, Salter Harris fracture. PHYSICAL EXAM: The athlete was admitted to Children’s Hospital. He complained about pain and swelling in the lateral aspect of the left ankle. He ended up landing abnormally on his left foot. CTĬomplex metaphyseal or epiphyseal fractures can be further assessed at CT.CASE HISTORY: An amateur, 14-year-old soccer player celebrated his goal by attempting a backflip. If the fracture is completely within the physis, there is no bony abnormality and there may just be widening or narrowing of the physis which can be challenging to diagnose at the initial presentation. X-rays are usually all that is required to make the diagnosis. When the fracture passes towards the epiphysis, it passes through the zones of proliferation and reserve which result in possible premature closure of the growth plate at the fracture site. Fortunately, this is not a region of active growth, and therefore fractures through this area have a good prognosis. Fractures tend to propagate along the weakest zone, which is the spongiosum. The growth plate has five distinctive zones. Physeal fractures are most common in 10-to-16-year-old children, except for elbow fractures, which are more common in 3-to-6-year-old children 2. They most commonly occur following trauma, although at the hip, a slipped upper femoral epiphysis (SUFE) is a type I fracture that can occur without an acute traumatic event. Physeal fractures represent ~35% of all skeletal injuries in children 2. Physeal fractures are also commonly called Salter-Harris fractures because the dominant and ubiquitous classification for these injuries is the Salter-Harris classification.
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