Salter-Harris type II fracture of proximal radius

Case contributed by Leonardo Lustosa

Presentation

Pain and swelling after falling on the outstretched arm

Patient Data

Age: 7 years
Gender: Male

There is a fracture line below the radial head ossification center. The capitellum, radial head, and internal epicondyle ossification centers can be observed as expected of a 7-year old. Sail sign and posterior fat pad sign indicate elbow joint effusion.

The fracture line passes across the growth plate and through the metaphysis, characterizing a type 2 Salter-Harris fracture.

Sail sign and posterior fat pad sign indicating elbow joint effusion (red highlights).

Normal appearance of the elbow ossification centers (blue highlights) at 7 years.

Case Discussion

The present case is a type 2 Salter-Harris fracture as the fracture line passes across the growth plate and through the metaphysis.

Salter-Harris classification is used to describe physeal fractures. The classification can be remembered using the SALTR mnemonic:

  • S: slipped (type I)
  • A: above or away from joint (type II)
  • L: lower (type III)
  • T: through or transverse or together (type IV)
  • R: ruined or rammed (type V)

In a pediatric elbow radiograph evaluation, it is important to be familiar with the expected ossification centers' appearance by age. They can be remembered using the CRITOE mnemonic:

  • C: capitellum
  • R: radial head: 
  • I: Internal (medial) epicondyle
  • T: trochlea
  • O: olecranon
  • E: external (lateral) epicondyle

Case contributed by Dr. Francisco Abaeté, M.D., PhD.

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