Salter-Harris type V fracture

Salter-Harris type V fractures are very uncommon injuries that occur in children. These fractures involve a crush injury of the physis secondary to compressive forces that involve all or part of the physis . In general Salter-Harris fractures are childhood injuries where there is a fracture that involves the physis.

Salter-Harris V injuries often have a poor prognosis due primarily to disruption of the germinal matrix and associated vascular supply leading to potential bone growth arrest, altered joint mechanics and functional impairment. As such orthopedic evaluation and subsequent operative intervention are often required .

Epidemiology

Less than 1% of physeal fractures will be a Salter-Harris type V fractures. They are rare and usually retrospectively identified.

Radiographic features

Almost all Salter-Harris type V fractures are occult on initial imaging. They are usually retrospectively identified during follow up when there is clinical deformity or radiographic evidence of growth arrest.

Plain radiograph

• often radiographically occult although narrowing of the physis may be noted
• these fractures are typically diagnosed retrospectively after structural deformity has begun to occur secondary to growth plate arrest
• adjacent soft tissue swelling and joint effusion may be noted

CT

• CT imaging can be incorporated to evaluate focal osseous bridging across the physis during the healing process (most common in Salter-Harris IV and V injuries)