X-ray of fractures in children
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Author:
Mikael Häggström [notes 1]
In patients with remaining growth plates:
Contents
Detection
Even if there's an initial obvious fracture, evaluate:
- Bone contours for disruptions
- Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)
Growth plate fractures
Growth plate fractures are also called Salter-Harris fractures.
SALTER mnemonic for classification
The mnemonic "SALTER" can be used to help remember the first five types.[1][2][3]
This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.
- I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
- II – A = Above. The fracture lies above the physis, or Away from the joint.
- III – L = Lower. The fracture is below the physis in the epiphysis.
- IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
- V – R = Rammed (crushed). The physis has been crushed.
Salter–Harris I fracture of distal radius.
Salter–Harris II fracture of ring finger proximal phalanx.
Salter–Harris III fracture of big toe proximal phalanx.
Follow-up of fractures
In children, the following timeline of radiologic features is expected:
Resolution of soft tissues | 7-10 days (or 2-21 days) |
Gap widening | 4-6 weeks (56%) |
Periosteal reaction | 7 days - 7 weeks |
Marginal sclerosis | 4-6 weeks (85%) |
First callus | 4-7 weeks (100%) |
Radiodensity of callus > cortex | 13 weeks (90%) |
Bridging callus | 2.6 - 13 weeks |
Periosteal incorporation | 14 weeks |
Remodeling | 9 weeks (50%) |
See also
- X-ray of fractures for classification and reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Davis, Ryan (2006). Blueprints Radiology . ISBN 9781405104609. Retrieved on March 3, 2008.
- ↑ . Salter-Harris Fractures. OrthoConsult. Retrieved on 5 February 2017.
- ↑ Tidey, Brian. Salter-Harris Fractures. Retrieved on March 3, 2008.
- ↑ Unless otherwise specified in boxes, reference is:
- Prosser, Ingrid; Lawson, Zoe; Evans, Alison; Harrison, Sara; Morris, Sue; Maguire, Sabine; Kemp, Alison M. (2012). "A Timetable for the Radiologic Features of Fracture Healing in Young Children ". American Journal of Roentgenology 198 (5): 1014–1020. doi: . ISSN 0361-803X.
- Data is taken from scientific studies, notably Islam et al. where data is contradictory to radiology textbooks:
Islam, Omar; Soboleski, Don; Symons, S.; Davidson, L. K.; Ashworth, M. A.; Babyn, Paul (2000). "Development and Duration of Radiographic Signs of Bone Healing in Children ". American Journal of Roentgenology 175 (1): 75–78. doi: . ISSN 0361-803X.