No personal or non-personal information is collected. "", the logo, "A Pediatric Digital Library and Learning Collaboratory intended to serve as a source of continuing pediatric education" are all Trademarks of Donna M. D'Alessandro, M.D.Īll contents copyright © 2003-2023 Donna M. Subscribe to a mailing list to be notified monthly of new cases: The health professional works effectively with others as a member or leader of a health care team or other professional group.Īssociate Professor of Pediatrics, Children’s Hospital of Iowa Basic and clinically supportive sciences appropriate to their discipline are known and applied.ġ9. All medical and invasive procedures considered essential for the area of practice are competency performed.ġ1. Patient management plans are developed and carried out.ħ. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.Ĥ. Essential and accurate information about the patients is gathered.ģ. When interacting with patients and their families, the health care professional communicates effecively and demonstrates caring and respectful behaviors.Ģ. Fracture, Epiphyseal Plate (Salter Harris) Paediapaedia: Musculoskeletal Diseases. eMedicine.Īvailable from the Internet at (rev. Synopsis of Pediatric Emergency Medicine. To view current news articles on this topic check Google News. Information prescriptions for patients can be found at Pediatric Common Questions, Quick Answers for these topics: Fractures and Dislocations and Casts and Splints. To view pediatric review articles on this topic from the past year check PubMed. Radiology / Nuclear Medicine / Radiation Oncology How long should ice be applied to a musculoskeletal soft tissue injury? What are the indications for an orthopaedics consultation for a fracture?ģ. Computed tomography can be used for surgical planning.ġ. Generally plain radiographic examination is all that is needed to diagnose the fracture. Overall, only 30% of Salter-Harris fractures cause growth disturbance and 2% have significant functional problems. M = Metaphyseal involvement, E = Epiphyseal involvement, ME = Metaphyseal and Epiphyseal involvement. Type IV – fracture through the metaphysis, physis, and epiphysis - can lead to angulation deformities when healingįigure 24 – Diagram showing the Salter-Harris Fracture Classification System.Type III – fracture partway through the physis extending down into the epiphysis.Type II – fracture partway through the physis extending up into metaphysis.Type I – fracture through the physis (widened physis).This is because Type III and IV have intraarticular components and Type V crushes the physis (i.e. The classification has 5 types with the risk of complications increasing with the level. growth plate) they are unique to pediatrics. Because Salter-Harris fractures involve the physis (i.e. Robert Salter and William Harris classified injuries inolving the epiphyseal plate in their article from the Journal of Bone and Joint Surgery in 1963. For example, intrarticular fractures of the proximal great toe may need surgical pinning and a 5th metatarsal fracture (Jones Fracture) has a high rate of non union.ĭrs. Sometimes a bulky splint can also be applied.įractures of the great toe and the metatarsals can have higher risks of complications. For toe fractures that are non-displaced or minimally angulated, they can be adequately treated by buddy-taping the toe, and placement in a a hard-soled shoe using crutches. Toe and metatarsal fractures are common in children. The patient was to follow-up in approximately 1 week.įigure 23 – AP (left) and lateral (right) radiographs demonstrate a subtle Salter-Harris Type II fracture of the distal phalanx of the first toe. She was also instructed to rest, ice, and elevate her foot and use ibuprofen for pain control. She obtained some immediate relief with these measures. The patient was treated by ‘buddy-taping’ the great toe to the second toe as a splint, and placed into a cast boot to aid support. The radiologic evaluation confirmed the diagnosis of a Salter-Harris II fracture of the distal phalynx of the great toe. She has significant swelling and ecchymosis of the great toe, with point tenderness at the distal phalyngeal joint. The pertinent physical exam reveals a pre-teen in no acute distress. She has iced it several times, but it continues to swell, and has become ecchymotic and she is having some minor problems walking. Last evening she stubbed it on the floor as she was raising her leg for a kick in a martial arts class. A 12-year-old female came to clinic because of pain in her distal great toe.
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