![]() ![]() It may also occasionally involve the growth plate, appearing as physeal plate widening (Fig. Bone reabsorption makes the metaphyseal fracture line become radiographically distinct, usually 2 to 5 weeks after the injury (Fig. It is due to reabsorption involving an area of 1 to 2 mm of the bone at the metaphyseal fracture edges that have lost their blood supply. The delayed appearance of a fracture line following a physeal injury usually involves the metaphyseal segment of the physeal injury. It usually appears 4 to 5 weeks post-injury. Increased density due to the calcific callus formation is usually evident in the metaphyseal segment of the occult physeal injury (Fig. It is initially separable from the cortex but becomes incorporated in the cortex within a couple of months. The subperiosteal new bone formation is due to the full thickness detachment of the periosteum from the metaphysis and diaphysis (Fig. Periosteal reaction is usually evident at 2 weeks after the injury. The time of appearance of the radiographic signs of bone healing varies from a few days to 5 weeks, mainly depending on the age of the patient. There should be a clear distinction of these findings from the late radiographic signs of physeal injuries that are due to long-term complications, such as altered growth or premature closure of the growth plate, which are usually evident months or even years post-injury. These may include signs of periosteal healing and bone sclerosis, as well as the delayed appearance of a fracture line or a widened physeal plate. Radiographic diagnosis of the acute occult undisplaced Salter-Harris injuries of the extremities in children is usually secondary, referring to the findings that are consistent with the fracture healing process. Such injuries should be clinically suspected, since they are always followed by a varying severity of tenderness, swelling, pain and refusal to use the injured extremity, and appropriately treated. Occult undisplaced physeal fractures and specific bone bruises are the two subgroups of the acute occult Salter-Harris injuries in children. In the acute occult or obscure Salter-Harris injuries in children, there is no evidence of a fracture line at the initial anteroposterior and lateral radiographic survey. Traditionally, the appearance of a fracture line on plain radiographs is needed for the primary diagnosis of a fracture. Their grading is the most commonly used classification for pediatric physeal fractures and is based on radiographic appearance, causal mechanism and prognosis, concerning the disturbance of growth. Salter-Harris type III fractures describe a fracture through the epiphysis extending and continuing to the edge of the physis.Salter and Harris reported their five-part classification in children with open growth plates to grade fractures of the physeal plate according to the involvement of adjacent metaphysis and epiphysis. EpidemiologyĦ.5-8% of physeal fractures will be a Salter-Harris type III seen more often at the distal tibia and distal phalanx 2. ![]() Not all fractures that extend to the growth plate are Salter-Harris fractures. Salter-Harris fractures are injuries where a fracture of the metaphysis or epiphysis extends through the physis. The prognosis of type III fractures can be poor if the reduction is not correct, resulting in incongruence of the articular surface, as is the case with other intraarticular fractures 1. The fracture line is often obliquely oriented through the epiphysis to the physis where it will take a horizontal orientation extending to the edge of the physis. Salter-Harris type III fractures are an uncommon, intraarticular fracture physeal fractures that occur in children. ![]()
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