- Discussion:
- involves injury to distal tibial ephiphysis, & are due to plantar hyperflexion
or external rotation force;
- presents as SH II,
SH III, or
SH IV type injury of distal tibia which may disrupt
articular surface as well as physis;
-
Salter Harris III:
- involves medial side of distal physis;
- less common frx involving lateral half of distal tibial epiphysis is in
children near end of adolescence;
-
Salter Harris IV:
- cross union between epiphysis & metaphysis is main problem because
of resulting in cessation of growth on medial side of plate, & because
this is rarely achieved w/ closed reduction;
- Treatment:
- if these frx are not reduced and stabilized anatomically, growth deformity will result;
- closed reduction & insertion of percutaneously inserted transepiphyseal screw;
- may decrease incidence of local growth arrest;
- active motion can be initiated early;
- Complications:
- commonly associated w/ growth arrest leading to
varus deformity;
- due to asymmetric arrest of distal medial tibial growth plate:
- osseous bridge in medial part of physeal plate may develop after a Salter Harris III or IV injury;
- if the growth plate is damaged at the time of injury, even an undisplaced frx can develop a varus deformity;
-
radiographs:
- Harris growth arrest lines are seen to converge over the physis at the point of injury;
- damaged physis may appear radiodense;
- tomograms help define the bone bridge;
-
prevention:
- anatomical reduction of the fracture may reduce the incidence of
varus growth deformity;
- in late cases, consider
physeal bar resection or opening wedge supra-malleolar osteotomy;
