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Salter-Harris classification describes injuries of the physis, or growth plate, in children (Figure 29–1). There are five types with severity of injury to the growth plate increasing with each type. All suspected Salter-Harris fracture require follow up with a orthopedic physician. They are described as follows.

Figure 29–1.

Salter-Harris classification. (Reproduced, with permission, from Stone CK, Humphries RL: Current Diagnosis & Treatment Emergency Medicine, 7th ed. New York: McGraw-Hill, 2011. Copyright © McGraw-Hill Education LLC.)

Type I—Fracture line extends through the physis, separating epiphysis from metaphysis. There may be no radiographic evidence of the injury if no displacement is present. Therefore, diagnosis is based on clinical suspicion and point tenderness over the growth plate. If suspected, patients should be appropriately splinted with follow up with and orthopedic physician.

Type II—Most common of physeal fractures, these injuries begin in the physis and extend into the metaphysis. Low risk of growth disturbances in group I and II injuries.

Type III—Fracture extends from physis through epiphysis and into intra-articular space. It frequently requires operative fixation, therefore consultation with orthopedist should be sought.

Type IV—More commonly due to compressive forces with fracture extension from articular surface, through epiphysis and physis and involving metaphysis. Operative fixation is required with risk of partial or complete growth arrest despite appropriate treatment.

Type V—Crush injury to the physis most often seen in knee and ankle. These injuries have the highest risk of subsequent growth arrest and may be missed on initial radiographs due to lack of visible fracture. Diagnosis is often made in retrospect after growth arrest is noted. If suspected, extremity should be immobilized and follow-up with orthopedist should be arranged.


Essentials of Diagnosis

  • Sharp, clean amputations are best candidates for ­reimplantation.

  • Amputated parts should be cleaned gently, kept moist with saline, and placed on ice.

  • Cooling of amputated part helps to increase viability.

General Considerations

All traumatic amputations should be considered for reimplantation surgery. Sharp, complete amputations with minimal crush injury are the best candidates for successful reimplantation. Amputated parts should always accompany the patient. The part should be rinsed gently to clean a dirty wound, covered with saline-moistened gauze, placed in a bag, and then kept on ice (do not place amputated part directly on ice). Cooling of the amputated part improves viability from 6-8 hours to 12-24 hours. Significant blood loss can occur with amputations and close monitoring of vital signs is imperative.

Clinical Findings

Symptoms and Signs

When a patient presents with an amputated digit or limb, evaluation should include crush injury to both sides of the amputation. ...

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