Salter-Harris Fracture in Children

Photo of a doctor examining a foot.
Your physical therapist can help if your child has a Salter-Harris fracture. Lisa Blue/Getty Images

Definition:

A Salter-Harris fracture is a break near, through, or along the growth plate in a bone. This usually occurs in young children or adolescents, and it may cause functional limitations in walking and running (if the fracture is in the knee or ankle), or reaching and lifting (in an upper extremity fracture).

What is the Growth Plate?

Your bones are living, growing things. They are constantly breaking down old bone cells and adding cells.

When you are young, there is an area near the ends of each bone called the growth plate. It is in this area where bones grow and become longer.

The growth plate is located near the ends of the long bones in the body near the joint where two bones come together. A break in the bone here can be dangerous because it may limit normal growth in a particular bone, leading to deformity or a smaller length of bone on one side of a growing child's body. It may also interfere with normal joint motion, which can have a negative impact on function.

Causes of Salter-Harris Fractures

About one in three growth plate fractures are the result of sports participation. Frequently, these fractures occur slowly over time due to repetitive strain and are considered stress fractures. Occasionally, trauma to a bone from a fall or motor vehicle accident can cause a Salter-Harris fracture.

What are the Signs and Symptoms of a Salter-Harris Fracture?

The signs and symptoms of a Salter-Harris fracture include, but are not limited to:

  • Pain over the end of a bone or near the joint line
  • Swelling near the injured joint
  • Deformity near the injured area
  • Inability to put weight on the injured body part

Initial Treatment of a Growth Plate Fracture

If you suspect you or your child has a growth plate fracture, you must seek medical attention right away.

Go to your doctor or report to your local emergency department for proper diagnosis and treatment.

Diagnosis of a Salter-Harris fracture is made by simple x-rays. Occasionally, advanced diagnostic imaging, like a CT scan or MRI, is necessary to see the growth plate fracture. Once the diagnosis is confirmed, the fracture will need to be reduced. This is the process where the bone pieces are put in the correct place to ensure proper healing.

Frequently, Salter-Harris fractures can be manually reduced, which means that your doctor can use his or her hands to put the bones in the correct position. For severe fractures, pinning may be necessary, or a surgical procedure called an open reduction internal fixation (ORIF) may be required. Be sure to speak with your doctor to understand the procedure that is used to reduce the fracture.

After your fracture is reduced, your injury will likely be immobilized in a cast. Sometimes, you may not be allowed to put weight on your injured body part. If the Salter-Harris fracture is in your ankle or knee, this means that you may have to use crutches or a walker to get around.

You may require a physical therapist to help you learn to use your assistive device.

If the fracture is in your hand, wrist, elbow or shoulder, you may be required to wear a sling. Your physical therapist can help you learn how to properly adjust the sling to make sure it is fitted properly.

Physical Therapy for a Salter-Harris Fracture

After 6-8 weeks of immobilization, physical therapy may be started to help you regain normal mobility after a Salter-Harris fracture. The impairments that you may work on in physical therapy include:

  • Range of motion (ROM): After a period of immobilization, your ability to fully move your injured body part may be limited. Your physical therapist can help you regain normal ROM with specific exercises and techniques. Flexibility exercises may be required to help stretch tight muscles and joints, and joint mobilizations may be used to improve your ROM.
  • Strength: You may notice that the strength in the muscles around your injured bone has decreased since the injury. Strengthening exercises can help improve your ability to use your injured body part normally. Your physical therapist can prescribe exercises to help improve your strength after a Salter-Harris fracture.

    If you are returning to sports, plyometric strengthening exercises may be necessary. These exercises can help improve your coordination and speed and ensure that your healed bone can tolerate the significant forces and stresses that sports cause.

  • Gait: If you have injured the growth plate of your ankle or knee, you may have difficulty walking. Gait training may be necessary to help improve your walking ability. Balance and proprioception exercises may be prescribed to help you walk better.
  • Swelling and pain: After a period of immobilization, you may still have pain in the injured bone after a growth plate fracture. Your physical therapist may prescribe physical agents and modalities to help manage the pain and swelling that you are experiencing.
  • Scar tissue management (if you had surgery): After a surgical procedure, scar tissue may be present near the incision. Your physical therapist can perform scar tissue massage and mobilization to help improve the mobility of your scar.
  • Function: Your physical therapy program after a Salter-Harris fracture should focus on function. What are you unable to do as a result of your fracture? Your physical therapist can help you improve your ability to perform everyday tasks like reaching and walking.

A Salter-Harris fracture can be a painful experience, and it may lead to significant loss of mobility if not treated properly. You may be unable to participate fully in sports and physical education class, and you may have difficulty performing basic tasks, like walking or lifting items, after a fracture. Physical therapy can help you safely return to normal activity and function after a Salter-Harris fracture.

Source:

Wheeless' Textbook of Orthopedics.

Also Known As: Growth plate fracture

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