0:00

Let's spend a few minutes

0:02

and talk about physeal injury.

0:05

And this is, of course, the Salter

0:08

Harris Classification System.

0:11

One thing to remember about this

0:12

classification system is that it can only

0:14

be applied if your physis is still open.

0:18

Once your physis has closed,

0:21

this system cannot be applied.

0:23

Because it's a system that talks

0:26

about prognosis, it has implications

0:28

for growth, it has implications

0:31

for varus and valgus abnormalities.

0:35

So, once the physis is closed,

0:38

those things are less relevant.

0:42

How do we know a physis is open?

0:44

Well, you look at the skeletal system and

0:45

you see little bands of lucency. That's

0:49

how you know the physis is still open.

0:51

When the physis does close, it'll

0:53

have what's called a physeal scar.

0:55

So the band of tissue between the

0:57

epiphysis will sort of be white.

0:59

And over time, this will disappear

1:01

and it'll look like a single bone.

1:04

So, the Salter Harris system can only

1:06

be applied again if your physis is open.

1:09

Here we have a characteristic

1:11

image that demonstrates a physis.

1:13

So, we're looking at the physis.

1:15

So, we're, of course, talking about this.

1:18

That is your physis.

1:20

Any Salter Harris injury has to

1:23

involve the physis to some degree.

1:26

I'll write that.

1:27

So, a Salter Harris I injury, which is

1:30

sometimes very difficult to tell because

1:32

you're looking for widening of that physis.

1:35

It has to go directly

1:37

through the physis like this.

1:40

As you can imagine, if there's already a lucency

1:43

there on radiograph, seeing a slight widening

1:47

of that lucency can be a little problematic.

1:50

That's why you have the contralateral side

1:52

and other adjacent physes to help you.

1:55

For example, the fibular physis.

1:59

Sometimes if you have a fracture to the

2:00

physis of the distal tibia, you can compare

2:02

it to the width of the physis of the

2:05

fibula, and then you can determine whether

2:07

you think there is a fracture or not.

2:09

So, that's a Salter I injury.

2:11

Salter II injury, again, has to

2:13

involve the physis, and it goes

2:16

through the metaphysis that way.

2:19

Okay?

2:20

That's Salter II.

2:22

And it goes through the

2:23

metaphysis in any direction.

2:25

Salter III goes through the

2:27

physis and exits the metaphysis.

2:30

out the epiphysis.

2:32

Salter IV goes through the physis and involves

2:37

both the metaphysis and the epiphysis.

2:42

And finally, a Salter Harris V, which is

2:46

also a little difficult, involves just

2:49

the physis, but the physis is crushed.

2:54

So that lucency or that gap that you see

2:58

is actually narrower than it should be.

3:00

So that's a Salter Harris V injury, okay?

3:04

And why do we do that?

3:05

Why do we classify?

3:07

Because Salter Harris injury

3:08

has a prognostic factor.

3:11

It lets us know what the likelihood of physeal

3:14

bar formation, leg length discrepancy, things

3:18

like that are, what are the possibilities.

3:21

The higher the Salter Harris

3:22

number, the worse the prognosis.

3:25

But it's not just the Salter Harris that we

3:28

have to worry about as far as physeal injury.

3:30

The particular physis actually

3:32

has a lot to do with it.

3:34

For example, the majority of physeal

3:38

injuries happen around the fingers, like

3:40

the DIP, PIP, around that area.

3:44

Yet, the majority of physeal-related

3:47

complications happen around the knees.

3:51

So it's, no matter what the

3:53

classification of the Salter Harris.

3:55

If the Salter Harris is four or five,

3:58

if it's in the fingers, you end up

4:00

not having as many complications as

4:02

even a two or three around the knees.

4:04

So Salter Harris is one thing to think about.

4:06

Also, which particular physes

4:09

are involved is another thing to think

4:11

about when we look at complications.62 00:02:30,315 --> 00:02:31,295 out the epiphysis.

2:32

Salter IV goes through the physis and involves

2:37

both the metaphysis and the epiphysis.

2:42

And finally, a Salter Harris V, which is

2:46

also a little difficult, involves just

2:49

the physis, but the physis is crushed.

2:54

So that lucency or that gap that you see

2:58

is actually narrower than it should be.

3:00

So that's a Salter Harris V injury, okay?

3:04

And why do we do that?

3:05

Why do we classify?

3:07

Because Salter Harris injury

3:08

has a prognostic factor.

3:11

It lets us know what the likelihood of physeal

3:14

bar formation, leg length discrepancy, things

3:18

like that are, what are the possibilities.

3:21

The higher the Salter Harris

3:22

number, the worse the prognosis.

3:25

But it's not just the Salter Harris that we

3:28

have to worry about as far as physeal injury.

3:30

The particular physis actually

3:32

has a lot to do with it.

3:34

For example, the majority of physeal

3:38

injuries happen around the fingers, like

3:40

the DIP, PIP, around that area.

3:44

Yet, the majority of physeal-related

3:47

complications happen around the knees.

3:51

So it's, no matter what the

3:53

classification of the Salter Harris.

3:55

If the Salter Harris is four or five,

3:58

if it's in the fingers, you end up

4:00

not having as many complications as

4:02

even a two or three around the knees.

4:04

So Salter Harris is one thing to think about.

4:06

Also, which particular physes

4:09

are involved is another thing to think

4:11

about when we look at complications.