Rethink the Salter-Harris I Fracture

The last 50 years of pediatric fracture management may have included a substantial misunderstanding of Salter and Harris’s original findings. In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking for a half century: why do we immobilize bones that are clinically and radiographically normal? The infamous Salter-Harris type I fracture has, in many settings, become the most common type of pediatric ‘fracture’. And yet the diagnosis is, in the overwhelming majority of cases, provisional… preliminary… potential. That is because Salter-Harris I fractures are typically diagnosed in the setting of normal x-rays and subjective bony tenderness at a growth plate. In other words, when there is no objective evidence of fracture. Turns out Drs. Robert Salter and Robert Harris may have been thinking about something quite different. In the seminal 1963 publication outlining their classification system the two pediatric orthopedists offer an explanation of type I fractures as “resulting from a shearing or avulsion force”, and “most commonly associated with birth injuries.” They go on to describe their management, saying “reduction is not difficult.” The paper includes 12 reproduced radiographs and one illustration of type I fractures. All of these include visually conspicuous separation of the epiphysis from the metaphysis...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news