![]() ![]() This is a case series of 3 children with distal femoral injuries. Obscure distal femoral epiphyseal injury. However, it seems like these will be clinically obvious: ![]() However, to be clear, there may be significant growth plate injuries that are not displaced at the time of assessment, and will have negative x-rays. The incidence of true growth plate injuries is very low, and even those that occur are of questionable clinical relevance. The idea that ligament is stronger than bone is a myth. And even more important, at 1 month follow up, there was no difference in function between those with MRI confirmed fracture and those without. Only 4 children (3.0%, 95% CI 0.1-5.9%) actually has Salter Harris 1 fractures, and only 2 of those had any evidence of growth plate injury. Of the 140 children, 108 had ligamentous injuries on MRI. Then all of the children had an MRI at one week. They were all treated with a removable splint. This is a larger prospective cohort of 140 children between 5 and 12 years of age with clinically suspected Salter Harris 1 fractures of the ankle. Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain? JAMA pediatrics. They all had sprains or boney contusions.īoutis K, Plint A, Stimec J. This is a prospective cohort of 18 pediatric patients, who had trouble ambulating and maximal tenderness at distal fibular growth plates. None of the 18 children had fractures. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. What gives?īoutis K, Narayanan UG, Dong FF, et al. But I have seen thousands of kids with sprained ankles, and must have sprained my own ankle a hundred times growing up. Therefore, you never diagnose a pediatric patient with a sprain. I am sure we have all heard that in children ligaments are stronger than bones. This is one of those ideas that never made any sense to me. Are childrens’ ligaments stronger than their bone? When you think Salter-Harris 1, don’t think sprained ankle, think slipped capital femoral epiphysis (SCFE). ![]() These injuries are complete separations of the epiphysis from the metaphysis that will usually require a reduction. Bottom line: We have misunderstood the definition of a Salter-Harris type 1 injury. This means we have seen a huge indication creep when it comes to pediatric casting. Does that fit your current practice? It certainly did not fit mine. This means that for every 1 Salter-Harris 1 fracture you see, you should see more than 15 Salter-Harris 2-5s. The fact that Salter-Harris 1 injuries are displaced seems to be recognized by a number of sources, but it certainly is not what I was taught in medical school and residency. For example, the radiologists at define a type 1 fracture as “slipped”: Īnother hint that we have completely misunderstood the definition of a Salter-Harris 1 injuries is the prevalence at which they are supposed to occur: In a type one injury, “there is complete separation of the epiphysis from the metaphysis without any bone fracture”. These injuries needed to be reduced. The classic example of a type 1 injury is a SCFE (slipped capital femoral epiphysis). This is the original description of Salter-Harris (epiphyseal plate) injuries by Drs. History: What is a Salter-Harris 1 fracture? Therefore, we should cast (or splint) all children with tenderness near the growth plate, regardless of x-ray findings. This myth is based on a few misunderstandings, which are outlined below. In children, ligaments are stronger than bone, so if there is pain near a growth plate, we should assume that it is an injury to the bone not the ligament. The traditional teaching about Salter-Harris 1 injuries goes something like this: Because the injury is directly to the growth plate, these injuries will be invisible on x-ray. ![]()
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