*15-years-old boy with ankle pain and swelling after injury.
What is the most likely diagnosis?
Answer
Answer: Salter-Harris type III fracture of distal tibia
Case Discussion:
CT images demonstrate Salter-Harris type III fractures of extending to ankle joint with fracture of growth plate of lower end of tibia.
The Salter-Harris classification was proposed by Salter and Harris in 1963 and at the time of writing (2016) remains the most widely used system for describing physeal fractures.
Classification:
- type I
- 5-7%
- fracture plane passes all the way through the growth plate, not involving bone
- type II
- ~75% (by far the most common)
- fracture passes across most of the growth plate and up through the metaphysis
- type III
- 7-10%
- fracture plane passes some distance along with the growth plate and down through the epiphysis
- type IV
- intra-articular
- 10%
- fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
- type V
- uncommon <1%
- crushing type injury does not displace the growth plate but damages it by direct compression
- type VI: injury to the perichondral structures
- type VII: isolated injury to the epiphyseal plate
- type VIII: isolated injury to the metaphysis, with a potential injury related to endochondral ossification
- type IX: injury to the periosteum that may interfere with membranous growth
References:
1. Salter R, Harris WR. Injuries Involving the Epiphyseal Plate. J Bone Joint Surg Am 1963. 45 (3) 587-622.
2. Ralph Weissleder, Jack Wittenberg, Mukesh G. Harisinghani. Primer of Diagnostic Imaging. (2003) ISBN: 0323023282.