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paediatric

Salter-Harris Classification and Physeal Fractures

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 12-year-old boy presents after an inversion injury to his right ankle while playing basketball. He heard a "crack" and has immediate swelling and inability to weight bear. On examination, there is significant swelling around the distal tibia with point tenderness over the physis. The ankle is in slight varus. There is no open wound. Distal pulses and sensation are normal.
AP and lateral ankle radiographs in a 12-year-old child demonstrating a Salter-Harris Type II fracture of the distal tibia. The fracture line extends through the physis (S = separation) and exits through the metaphysis (A = above). A Thurston-Holland fragment is visible on the lateral side. The fibula is intact. The distal tibial physis is widened medially. This injury pattern is at risk for premature physeal closure.
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AP and lateral ankle radiographs in a 12-year-old child demonstrating a Salter-Harris Type II fracture of the distal tibia. The fracture line extends through the physis (S = separation) and exits through the metaphysis (A = above). A Thurston-Holland fragment is visible on the lateral side. The fibula is intact. The distal tibial physis is widened medially. This injury pattern is at risk for premature physeal closure.

Source: Educational radiograph of a Salter-Harris type II fracture • OrthoVellum Medical Education Team • OrthoVellum Educational Use

Questions

Question 1 (4 marks)

Describe the Salter-Harris classification with the SALTR mnemonic.

Question 2 (5 marks)

What determines the prognosis and risk of growth arrest?

Question 3 (6 marks)

How do you manage each Salter-Harris type?

Question 4 (5 marks)

Describe special fracture patterns around the pediatric ankle.

Question 5 (4 marks)

What is the management of physeal arrest?

Question 6 (4 marks)

What are the key principles of fixation across the physis?

Exam Day Cheat Sheet

Must Mention

  • •SALTR: Straight/Above/Lower/Through/Rammed
  • •Type II most common (75%)
  • •Higher type = worse prognosis
  • •Distal tibia = highest arrest risk
  • •Tillaux = SH III, triplane = multiplanar
  • •Type III/IV need anatomic reduction

Common Pitfalls

  • •Wrong SALTR types
  • •Missing location risk
  • •No CT for triplane
  • •Wrong fixation approach
  • •Missing Tillaux pattern
  • •Not knowing bar resection