0:00

Now that we have a basic understanding of

0:02

what Salter-Harris injuries look like from

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the cartoon diagrams I showed you before,

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let's look at some practical examples.

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Uh, we're going to start out

0:10

with a Salter-Harris II.

0:12

This is a shoulder of a 14-year

0:15

old boy who injured himself.

0:17

I think one of the first things we

0:18

notice as we look at this, is this

0:20

little piece of bone that has sort

0:21

of fallen into the axillary recess.

0:24

Uh, but as we look more closely, I begin

0:26

to wonder, is there a little bit of

0:28

widening, asymmetric widening here at the

0:30

very lateral aspect of that, uh, proximal

0:33

humerus, uh, compare the width over here

0:35

versus the width down here, um, hard to say.

0:39

Let's see what other views look like.

0:42

Here is sort of a, uh, Y view, if you will.

0:46

If you can appreciate it, here's the

0:48

coracoid process anteriorly, the acromion

0:51

is going to be somewhere over here, and the

0:53

glenoid is going to be somewhere over here.

0:54

So, maybe there's a little inferior

0:57

subluxation, but again, hard to say.

1:00

What I notice first of all, besides that,

1:03

is the fact that as I try to follow the

1:05

growth plate this way, I see a little

1:09

step-off right over here between this

1:11

piece of bone and this piece of bone.

1:14

That suggests maybe there is a metaphyseal

1:17

component to this injury, because this bone

1:20

should really line up with that bone over here.

1:22

This axillary view is, uh, not

1:25

very helpful, I don't think.

1:26

We just know here that there's no dislocation.

1:28

We know this is anterior because

1:30

this is the coracoid process.

1:31

The coracoid process is always the most

1:34

anterior structure in the shoulder.

1:36

So when we see this, uh, and here's the

1:38

glenoid right over here, there's good

1:39

congruity between the glenoid surface

1:42

and the surface of your humeral head.

1:44

So no shoulder dislocation.

1:47

And finally, another look at that oblique.

1:49

Coracoid process, again that little

1:51

step-off here bothers me a little bit,

1:53

maybe a slight widening over here.

1:54

So I'm suspecting a Salter-Harris injury of

1:57

some sort in addition to this little piece of

2:00

bone that's fallen off into the axillary recess.

2:04

In the next vignette, I'm going to show you what

2:07

the MRI of this particular pathology looks like.