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Salter-Harris IV Injury

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0:01

Okay, so I want to show you the

0:03

final of the Salter-Harris injuries.

0:05

We're not going to do Salter-Harris

0:06

5, uh, but that's a crush injury.

0:08

This is going to be a Salter-Harris Type IV injury.

0:11

And again, we're bringing you back to the knee.

0:14

Skeletally immature patient.

0:16

The image on your left is a fat

0:18

suppressed fluid-sensitive sequence.

0:20

The middle is a T1-weighted sequence.

0:22

And the right is my favorite

0:25

dual echo steady state.

0:26

So, if you take a look at this, you notice that

0:29

there's a lot of edema involving the epiphysis,

0:32

involving the growth plate on the, on the, uh,

0:35

lateral side, and also the metaphysis here.

0:39

On the T1-weighted sequence, in the

0:41

corresponding areas, you see areas of

0:43

decreased signal corresponding to edema.

0:46

And on the dual echo steady state sequence,

0:49

we in fact see a beautiful example of

0:52

cortical separation here at the epiphysis.

0:55

Fracture going through the epiphysis proper.

0:58

Look how wide that growth plate is

1:01

on this side versus the other side.

1:03

So we know indeed that this area is involved.

1:06

And finally, we can see a little

1:07

piece of bone over here in the

1:09

metaphysis that has flecked off.

1:11

So we know the fracture line extends this way,

1:15

goes up vertically into the joint space through

1:18

the epiphysis, and exits inferiorly through

1:21

the metaphysis into the adjacent periosteum.

1:24

So, this is a great example of a

1:26

Salter-Harris Type IV injury.

1:28

Um, again, because it's happening in the

1:30

knee, because it's Salter-Harris Type IV, the

1:33

likelihood of this forming into a FICL bar

1:36

or, um, growth disturbance is going to be

1:39

higher than had it been elsewhere or had it

1:42

been a lower grade of Salter-Harris injury.

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Faculty

Mahesh Thapa, MD, MEd, FAAP

Division Chief of Musculoskeletal Imaging, and Director of Diagnostic Imaging Professor

Seattle Children's & University of Washington

Tags

Trauma

Pediatrics

Musculoskeletal (MSK)

MRI

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