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Physeal Injury (Salter-Harris Fracture)
Andrew Sonin, MD, FACR; Donna G. Blankenbaker, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Salter-Harris (SH) fracture
          • Synonyms

            • Salter fracture
          • Definitions

            • Fracture affecting physis in skeletally immature patient

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Zbojniewicz AM et al: Focal Periphyseal Edema (FOPE) zone on MRI of the adolescent knee: a potentially painful manifestation of physiologic physeal fusion? AJR Am J Roentgenol. 197(4):998-1004, 2011
                                        2. Basener CJ et al: Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma. 23(9):663-7, 2009
                                        3. Leary JT et al: Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop. 29(4):356-61, 2009
                                        4. Mubarak SJ et al: Classification of proximal tibial fractures in children. J Child Orthop. 3(3):191-7, 2009
                                        5. Shi DP et al: Epiphyseal and physeal injury: comparison of conventional radiography and magnetic resonance imaging. Clin Imaging. 33(5):379-83, 2009
                                        6. Cottalorda J et al: Salter-Harris Type III and IV medial malleolar fractures: growth arrest: is it a fate? A retrospective study of 48 cases with open reduction. J Pediatr Orthop. 28(6):652-5, 2008
                                        7. Arkader A et al: Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop. 27(6):703-8, 2007
                                        8. Schnetzler KA et al: The pediatric triplane ankle fracture. J Am Acad Orthop Surg. 15(12):738-47, 2007
                                        9. Ilharreborde B et al: Long-term prognosis of Salter-Harris type 2 injuries of the distal femoral physis. J Pediatr Orthop B. 15(6):433-8, 2006
                                        10. Rohmiller MT et al: Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure? J Pediatr Orthop. 26(3):322-8, 2006
                                        11. Craig JG et al: The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume. Skeletal Radiol. 33(6):337-44, 2004
                                        12. Swischuk LE et al: Frequently missed fractures in children (value of comparative views). Emerg Radiol. 11(1):22-8, 2004
                                        13. Barmada A et al: Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor. J Pediatr Orthop. 23(6):733-9, 2003
                                        14. Ecklund K et al: Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol. 178(4):967-72, 2002
                                        15. Koury SI et al: Recognition and management of Tillaux fractures in adolescents. Pediatr Emerg Care. 15(1):37-9, 1999
                                        16. Carey J et al: MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol. 27(5):250-5, 1998
                                        17. Rodgers WB et al: Chronic physeal fractures in myelodysplasia: magnetic resonance analysis, histologic description, treatment, and outcome. J Pediatr Orthop. 17(5):615-21, 1997
                                        18. Shih C et al: Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology. 195(3):855-9, 1995
                                        19. Rogers LF et al: Imaging of epiphyseal injuries. Radiology. 191(2):297-308, 1994
                                        20. Ogden JA: Injury to the growth mechanisms of the immature skeleton. Skeletal Radiol. 6(4):237-53, 1981
                                        21. Salter RB et al: Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 45:587-622, 1963
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Salter-Harris (SH) fracture
                                                • Synonyms

                                                  • Salter fracture
                                                • Definitions

                                                  • Fracture affecting physis in skeletally immature patient

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Zbojniewicz AM et al: Focal Periphyseal Edema (FOPE) zone on MRI of the adolescent knee: a potentially painful manifestation of physiologic physeal fusion? AJR Am J Roentgenol. 197(4):998-1004, 2011
                                                                              2. Basener CJ et al: Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma. 23(9):663-7, 2009
                                                                              3. Leary JT et al: Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop. 29(4):356-61, 2009
                                                                              4. Mubarak SJ et al: Classification of proximal tibial fractures in children. J Child Orthop. 3(3):191-7, 2009
                                                                              5. Shi DP et al: Epiphyseal and physeal injury: comparison of conventional radiography and magnetic resonance imaging. Clin Imaging. 33(5):379-83, 2009
                                                                              6. Cottalorda J et al: Salter-Harris Type III and IV medial malleolar fractures: growth arrest: is it a fate? A retrospective study of 48 cases with open reduction. J Pediatr Orthop. 28(6):652-5, 2008
                                                                              7. Arkader A et al: Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop. 27(6):703-8, 2007
                                                                              8. Schnetzler KA et al: The pediatric triplane ankle fracture. J Am Acad Orthop Surg. 15(12):738-47, 2007
                                                                              9. Ilharreborde B et al: Long-term prognosis of Salter-Harris type 2 injuries of the distal femoral physis. J Pediatr Orthop B. 15(6):433-8, 2006
                                                                              10. Rohmiller MT et al: Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure? J Pediatr Orthop. 26(3):322-8, 2006
                                                                              11. Craig JG et al: The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume. Skeletal Radiol. 33(6):337-44, 2004
                                                                              12. Swischuk LE et al: Frequently missed fractures in children (value of comparative views). Emerg Radiol. 11(1):22-8, 2004
                                                                              13. Barmada A et al: Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor. J Pediatr Orthop. 23(6):733-9, 2003
                                                                              14. Ecklund K et al: Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol. 178(4):967-72, 2002
                                                                              15. Koury SI et al: Recognition and management of Tillaux fractures in adolescents. Pediatr Emerg Care. 15(1):37-9, 1999
                                                                              16. Carey J et al: MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol. 27(5):250-5, 1998
                                                                              17. Rodgers WB et al: Chronic physeal fractures in myelodysplasia: magnetic resonance analysis, histologic description, treatment, and outcome. J Pediatr Orthop. 17(5):615-21, 1997
                                                                              18. Shih C et al: Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology. 195(3):855-9, 1995
                                                                              19. Rogers LF et al: Imaging of epiphyseal injuries. Radiology. 191(2):297-308, 1994
                                                                              20. Ogden JA: Injury to the growth mechanisms of the immature skeleton. Skeletal Radiol. 6(4):237-53, 1981
                                                                              21. Salter RB et al: Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 45:587-622, 1963