Physeal fractures (also called Salter-Harris fractures) are important childhood fractures that involve the physeal plate. They are relatively common and important to differentiate from other injuries because the involvement of the physis (growth plate) may cause premature closure resulting in limb shortening and abnormal growth.
Physeal fractures are also commonly called Salter-Harris fractures because the dominant and ubiquitous classification for these injuries is the Salter-Harris classification.
Physeal fractures represent ~35% of all skeletal injuries in children cit.
Physeal fractures are most common in 10-15 year old children cit. They most commonly occur following trauma although at the hip, SUFE (slipped upper femoral epiphysis) is a type I fracture that can occur without an acute traumatic event.
The growth plate has five distinctive zones. Fractures tend to propagate along the weakest zone, which is the spongiosum. Fortunately this is not a region of active growth, and therefore fractures through this area have a good prognosis. 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.
X-rays are usually all that is required to make the diagnosis. 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 diagnosis at the initial presentation.
Complex metaphyseal or epiphyseal fractures can be further assessed at CT>
MRI is useful for the assessment of a suspected physeal injury and will identify bone oedema adjacent to the injured physis.
- T1/PD: assessment of physis orientation
- STIR/PDfs: bone oedema
- DESS: thin-section volume imaging of the physis
describing a fracture
- fracture types
- fracture location
- diaphyseal fracture
- metaphyseal fracture
- epiphyseal fracture
- fracture displacement