Definition

What is a Salter-Harris fracture?

A Salter-Harris fracture is an injury to the growth plate area of a child’s bone.

The growth plate is a soft area of cartilage at the ends of long bones. These are bones that are longer than they are wide. Salter-Harris fractures can occur in any long bone, from fingers and toes, to arm and leg bones.

A child’s bone growth occurs mainly in the growth plates. When children are fully grown, these areas harden into solid bone.

The growth plates are relatively weak and can be injured by a fall, a collision, or excessive pressure.

It’s important to diagnose and treat a Salter-Harris fracture as soon as possible to ensure normal bone growth.

Types of Salter-Harris fractures

Salter-Harris fractures were first categorized in 1963 by Canadian doctors Robert Salter and W. Robert Harris.

There are five main types, distinguished by the way the injury impacts the growth plate and surrounding bone. The higher numbers have a higher risk of possible growth problems.

Type 1

This fracture occurs when a force hits the growth plate separating the rounded edge of the bone from the bone shaft.

It’s more common in younger children. About 5 percent of Salter-Harris fractures are type 1.

Type 2

This fracture occurs when the growth plate is hit and splits away from the joint along with a small piece of the bone shaft.

This is the most common type and happens most often in children over 10. About 75 percent of Salter-Harris fractures are type 2.

Type 3

This fracture occurs when a force hits the growth plate and the rounded part of the bone, but doesn’t involve the bone shaft. The fracture may involve cartilage and enter into the joint.

This type usually happens after age 10. About 10 percent of Salter-Harris fractures are type 3.

Type 4

This fracture occurs when a force hits the growth plate, the rounded part of the bone, and the bone shaft.

About 10 percent of Salter-Harris fractures are type 4. This can happen at any age, and it may affect bone growth.

Type 5

This uncommon fracture occurs when the growth plate is crushed or compressed. The knee and ankle are most often involved.

Fewer than 1 percent of Salter-Harris fractures are type 5. It’s often misdiagnosed, and the damage can interfere with bone growth.

Other types

Another four fracture types are extremely rare. They include:

  • Type 6 which affects connective tissue.
  • Type 7 which affects the bone end.
  • Type 8 which affects the bone shaft.
  • Type 9 which affects the fibrous membrane of the bone.

How common is a Salter-Harris fracture?

Salter-Harris fractures make up 15 to 30 percent of bone injuries in children. Most commonly these fractures occur in children and teenagers during sports activity. Boys are twice as likely as girls to have a Salter-Harris fracture. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of a Salter-Harris fracture?

Salter-Harris fractures most often occur with a fall or injury that causes pain. Other symptoms include:

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you or your loved one has any signs or symptoms listed above or you have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes a Salter-Harris fracture?

A growth plate fracture can occur just by a blunt trauma to the growth plates due to a fall or as a result of a motor vehicle collision. Repetitive stress on the growth plates can also result in a growth plate fracture. This can happen during training for a sporting event, in which the child may be participating in.

Risk factors

What increases my risk for a Salter-Harris fracture?

There are some factors which makes a person prone to growth plate fractures. A boy is more likely to suffer from a growth plate fracture than girls as growth plates close in girls faster than in boys. Majority of growth plate fractures occur during a sporting event or as a result of a fall. Biking, skating, and skateboarding also are one of the primary causes for growth plate fractures. Adolescents are more vulnerable to growth plate fractures than small children. Please consult with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is a Salter-Harris fracture diagnosed?

If you suspect a fracture, take your child to a doctor or the emergency room. Prompt treatment for growth plate fractures is important.

The doctor will want to know how the injury occurred, whether the child has had previous fractures, and whether there was any pain in the area before the injury.

They’ll likely order an X-ray of the area, and possibly of the area above and below the injury site. The doctor may also want an X-ray of the unaffected side to compare them. If a fracture is suspected but doesn’t show up in the image, the doctor may use a cast or splint to protect the area. A repeat X-ray in three or four weeks can confirm the fracture diagnosis by imaging new growth along the break area.

Other imaging tests may be needed if the fracture is complex, or if the doctor needs a more detailed view of soft tissue:

  • A CT scan and possibly an MRI may be useful for evaluating the fracture.
  • CT scans are also used as a guide in surgery.
  • An ultrasound may be useful for imaging in an infant.

Type 5 fractures are difficult to diagnose. A widening of the growth plate may provide a clue to this type of injury.

How is a Salter-Harris fracture treated?

Treatment will depend on the type of Salter-Harris fracture, the bone involved, and whether the child has any additional injuries.

Nonsurgical treatment

Usually, types 1 and 2 are simpler and don’t require surgery.

The doctor will put the affected bone in a cast, splint, or sling to keep it in the right place and protect it while it heals.

Sometimes these fractures may require nonsurgical realignment of the bone, a process called closed reduction. Your child may need medication for pain and a local or possibly general anesthetic for the reduction procedure.

Type 5 fractures are more difficult to diagnose and are likely to affect proper bone growth. The doctor may suggest keeping weight off the affected bone, to make sure that the growth plate isn’t damaged further. Sometimes the doctor will wait to see how bone growth develops before treatment.

Surgical treatment

Types 3 and 4 usually need a surgical realignment of the bone, called open reduction.

The surgeon will put the bone fragments into alignment and may use implanted screws, wires, or metal plates to hold them in place. Some Type 5 fractures are treated with surgery.

In surgery cases, a cast is used to protect and immobilize the injured area while it heals. Follow-up X-rays are needed to check on bone growth at the injury site.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage a Salter-Harris fracture?

The following lifestyles and home remedies might help you cope with a Salter-Harris fracture:

Recovery times vary, depending on the location and severity of the injury. Usually, these fractures heal in four to six weeks.

The length of time the injury remains immobilized in a cast or sling depends on the particular injury. The patients may need crutches to get around, if the injured limb shouldn’t be weight-bearing while it’s healing.

After the initial period of immobilization, the doctor may prescribe physical therapy. This will help the patients regain flexibility, strength, and range of motion for the injured area.

During the recovery period, the doctor may order follow-up X-rays to check on healing, bone alignment, and new bone growth. For more serious fractures, they may want regular follow-up visits for a year or until the patients’ bone is fully grown.

It may take time before the patients can move the injured area normally or resume sports. It’s recommended that patients with fractures involving a joint wait for four to six months before participating in contact sports again.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: March 15, 2018 | Last Modified: March 15, 2018

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