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For the next couple of cases, I want to

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briefly go over Salter-Harris injuries,

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uh, one of the most common types of

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fractures in the pediatric population.

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And, uh, many of you may know the

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classification, uh, type 1, type 2, type

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3, type 4, type 5, so on and so forth.

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You can easily look that up, what, what

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areas it involves, but I want to delve just a

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little bit deeper, a little bit more into

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detail and talk about why it's important

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to classify these lesions and, uh, what

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the significance of those lesions are.

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And I think it'll help if we just

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do a quick review, first, of what

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these Salter-Harris injuries look like.

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So, I'm going to draw a rudimentary

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metaphysis, physis, and epiphysis.

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So let's go, let's, let's go like this.

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So we're going to label this one.

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We're going to call this two.

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This is going to be three.

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This is going to be four.

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And this is going to be five.

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And as a separate tool, I'm going

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to choose a light blue area.

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And we're going to make a little

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area that represents the physis.

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And then I'm going to use a red marker

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to designate the area of injury.

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So, if a fracture goes

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directly through the physis,

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it doesn't extend to the epiphysis

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or the metaphysis, then it's 1.

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If it goes through the physis and

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exits through the metaphysis, it's 2.

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If the fracture goes through the

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physis and exits vertically out

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through the epiphysis, it's number 3.

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Number 4 has to involve the physis, but it

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can be in this direction, so it involves both

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the physis and the epiphysis, and number 5

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is a crush-type injury, like this, such that

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this physis is somewhat obliterated, okay?

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So that's what we all know

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about physeal injuries.

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What you may not know is it's further

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sort of subcategorized into a group,

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that's one and two, which is called the

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horizontal physeal injuries, and a second

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group involving these three, which is

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called the vertical physeal injuries.

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And why do we do that?

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Because if you have a horizontal injury

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involving just the physis and the

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metaphysis, the entirety of the proliferative

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zone of the physis is not involved.

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If you do have these longitudinal or vertical

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types of injuries, then you do have the

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germinal portion and the physis being involved.

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3, 4, and 5, which are the longitudinal types,

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have a 75 percent rate of physeal bar formation.

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However, the horizontal portion only

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has a 25 percent rate of physeal bar formation.

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And the story gets even more complicated.

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Which part of the body is

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involved makes a big difference.

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In fact, it makes a bigger difference than

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the type of Salter-Harris injury you have.

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If you have involvement, for example, of

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your distal femur or proximal tibia, the

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rate of bridge formation is extremely high.

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35%, 16 percent, respectively.

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Although, only about 12 percent of all

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physeal injuries involve those two bones.

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What's the most common place for physeal injury?

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It's around your hands,

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your fingers, and so forth.

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In fact, most physeal

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injuries occur in your hands.

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However, the rate of these physeal

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bar formation is actually quite low

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when it involves those two areas.

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So it really depends on which part of

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the body you have a physeal injury and

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whether it's considered a horizontal

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type of injury or if it's considered a

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vertical or longitudinal type of injury.

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So with that preamble in mind, let's go on and

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look at some physeal injury types of cases.