Interactive Transcript
0:00
Let's spend a few minutes
0:02
and talk about physeal injury.
0:05
And this is, of course, the Salter
0:08
Harris Classification System.
0:11
One thing to remember about this
0:12
classification system is that it can only
0:14
be applied if your physis is still open.
0:18
Once your physis has closed,
0:21
this system cannot be applied.
0:23
Because it's a system that talks
0:26
about prognosis, it has implications
0:28
for growth, it has implications
0:31
for varus and valgus abnormalities.
0:35
So, once the physis is closed,
0:38
those things are less relevant.
0:42
How do we know a physis is open?
0:44
Well, you look at the skeletal system and
0:45
you see little bands of lucency. That's
0:49
how you know the physis is still open.
0:51
When the physis does close, it'll
0:53
have what's called a physeal scar.
0:55
So the band of tissue between the
0:57
epiphysis will sort of be white.
0:59
And over time, this will disappear
1:01
and it'll look like a single bone.
1:04
So, the Salter Harris system can only
1:06
be applied again if your physis is open.
1:09
Here we have a characteristic
1:11
image that demonstrates a physis.
1:13
So, we're looking at the physis.
1:15
So, we're, of course, talking about this.
1:18
That is your physis.
1:20
Any Salter Harris injury has to
1:23
involve the physis to some degree.
1:26
I'll write that.
1:27
So, a Salter Harris I injury, which is
1:30
sometimes very difficult to tell because
1:32
you're looking for widening of that physis.
1:35
It has to go directly
1:37
through the physis like this.
1:40
As you can imagine, if there's already a lucency
1:43
there on radiograph, seeing a slight widening
1:47
of that lucency can be a little problematic.
1:50
That's why you have the contralateral side
1:52
and other adjacent physes to help you.
1:55
For example, the fibular physis.
1:59
Sometimes if you have a fracture to the
2:00
physis of the distal tibia, you can compare
2:02
it to the width of the physis of the
2:05
fibula, and then you can determine whether
2:07
you think there is a fracture or not.
2:09
So, that's a Salter I injury.
2:11
Salter II injury, again, has to
2:13
involve the physis, and it goes
2:16
through the metaphysis that way.
2:19
Okay?
2:20
That's Salter II.
2:22
And it goes through the
2:23
metaphysis in any direction.
2:25
Salter III goes through the
2:27
physis and exits the metaphysis.
2:30
out the epiphysis.
2:32
Salter IV goes through the physis and involves
2:37
both the metaphysis and the epiphysis.
2:42
And finally, a Salter Harris V, which is
2:46
also a little difficult, involves just
2:49
the physis, but the physis is crushed.
2:54
So that lucency or that gap that you see
2:58
is actually narrower than it should be.
3:00
So that's a Salter Harris V injury, okay?
3:04
And why do we do that?
3:05
Why do we classify?
3:07
Because Salter Harris injury
3:08
has a prognostic factor.
3:11
It lets us know what the likelihood of physeal
3:14
bar formation, leg length discrepancy, things
3:18
like that are, what are the possibilities.
3:21
The higher the Salter Harris
3:22
number, the worse the prognosis.
3:25
But it's not just the Salter Harris that we
3:28
have to worry about as far as physeal injury.
3:30
The particular physis actually
3:32
has a lot to do with it.
3:34
For example, the majority of physeal
3:38
injuries happen around the fingers, like
3:40
the DIP, PIP, around that area.
3:44
Yet, the majority of physeal-related
3:47
complications happen around the knees.
3:51
So it's, no matter what the
3:53
classification of the Salter Harris.
3:55
If the Salter Harris is four or five,
3:58
if it's in the fingers, you end up
4:00
not having as many complications as
4:02
even a two or three around the knees.
4:04
So Salter Harris is one thing to think about.
4:06
Also, which particular physes
4:09
are involved is another thing to think
4:11
about when we look at complications.62 00:02:30,315 --> 00:02:31,295 out the epiphysis.
2:32
Salter IV goes through the physis and involves
2:37
both the metaphysis and the epiphysis.
2:42
And finally, a Salter Harris V, which is
2:46
also a little difficult, involves just
2:49
the physis, but the physis is crushed.
2:54
So that lucency or that gap that you see
2:58
is actually narrower than it should be.
3:00
So that's a Salter Harris V injury, okay?
3:04
And why do we do that?
3:05
Why do we classify?
3:07
Because Salter Harris injury
3:08
has a prognostic factor.
3:11
It lets us know what the likelihood of physeal
3:14
bar formation, leg length discrepancy, things
3:18
like that are, what are the possibilities.
3:21
The higher the Salter Harris
3:22
number, the worse the prognosis.
3:25
But it's not just the Salter Harris that we
3:28
have to worry about as far as physeal injury.
3:30
The particular physis actually
3:32
has a lot to do with it.
3:34
For example, the majority of physeal
3:38
injuries happen around the fingers, like
3:40
the DIP, PIP, around that area.
3:44
Yet, the majority of physeal-related
3:47
complications happen around the knees.
3:51
So it's, no matter what the
3:53
classification of the Salter Harris.
3:55
If the Salter Harris is four or five,
3:58
if it's in the fingers, you end up
4:00
not having as many complications as
4:02
even a two or three around the knees.
4:04
So Salter Harris is one thing to think about.
4:06
Also, which particular physes
4:09
are involved is another thing to think
4:11
about when we look at complications.
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