Salter Harris Fracture: Causes, Symptoms, Treatment and Cost

A Salter-Harris fracture is an injury to a child's growing bones. It is a type of fracture that occurs when the growth plate—the area of developing tissue near the ends of long bones is injured. The fracture is named after two orthopaedic surgeons, Robert Salter and Arthur Harris, who described it in 1963.

• Type I: This type of fracture is characterised by an injury that takes place at the epiphyseal growth plate with very little displacement of the fragments. It is further divided into two subtypes based on where the fracture line is relative to the growth plate:
• Type IA: fracture line passes through part of the growth plate and part of the metaphysis
• Type IB: fracture line passes through both parts of the growth plate and does not extend into the metaphysis
• Type II: This type of fracture involves an injury to both parts of the epiphyseal growth plate, resulting in a higher degree of displacement between fragment pieces. It also involves some damage to a portion in front or behind each side if it’s broken near one edge and not near its midline.
• Type III: In this type, there is a complete break through all three components—epiphysis, physis and metaphysis—creating three separate fragment pieces with significant displacement between them.
• Type IV: In this particular injury, there is a transphyseal break ('butterfly' fracture) directly through both sides across two planes (sagittal and transverse planes). This results in four separate fractures separated by large gaps that can be multiple millimetres in size.

• A Salter Harris fracture is a type of broken bone caused by trauma, usually from a fall or direct blow to the affected area.
• The fracture occurs when the growth plate (a region of cartilage at the end of long bones like the femur, tibia, and humerus) is damaged.
• It is most commonly seen in children and adolescents whose bones are still growing and developing.
• The fracture can also be caused by overuse or repetitive stress injuries due to athletics or activities that involve jumping, running, and other high-impact movements.

• Pain in the area of the injury or along a joint line
• Swelling at injury site
• Bruising at injured site
• Inability to walk, bear weight, or use limb normally

• Wear protective gear (such as shin guards) during contact or high risk sports.
• Use proper form for exercise and activities to reduce strain on bones.
• Have adequate amounts of calcium, vitamin D and other vitamins in a diet for strong bones.
• Avoid doing risky stunts or engage in stunts without safety equipment/guidance of an expert.
• Pay attention to children's activities, especially those activities with higher risk of fractures, such as skateboarding, skiing, etc.; monitor them closely to reduce risk of injury.

• Physical Examination: Examining the injured area, range of motion testing, swelling and bruising in the area, tenderness when touched and pain with movement
• X-ray Imaging: X-ray images can reveal if there is a clear fracture line through the epiphyseal plate or if fragments are displaced or out of alignment
• CT Scan: A CT scan will provide more detailed imaging than an X-ray image and can help identify displacement or fractures not visible on an X-Ray
• MRI Scan: An MRI scan can help identify soft tissue damage associated with Salter Harris fractures
• Bone Scan: A bone scan will help to confirm diagnosis and provide information on where damage has occurred inside the bones
• Classification/Treatment Plan: Depending on classification involved (Salter–Harris 1 through 5) your doctor will create a tailored plan for treatment involving either immobilisation or physical therapy with potentially surgery involvement

• Delayed or Incomplete Union: Salter-Harris fractures have a risk of incomplete fracture healing, partially due to the difficulties in obtaining accurate alignment of the fracture due to its presence in a joint.
• Limited Joint Mobility: The degree of joint mobility can be limited if not properly treated and managed, resulting in impaired function and disability.
• Osteoarthritis: If left untreated, complications such as osteoarthritis can occur secondary to joint hip damage caused by the incomplete healing of fractured bones associated with an Salter Harris fracture.
• Post-traumatic Stress Disorder: Psychological trauma associated with long-term disabilities or chronic pain caused by Salter-Harris fractures can lead to post-traumatic stress disorder (PTSD).

• The patient should apply warm compresses on the injured part for relieving pain and swelling.
• Ayurvedic herbs such as Ashwagandha, Guggul, Shalaparni, and Bala can be taken for strengthening the bones and improving the healing process.
• Nutritional supplements including calcium, magnesium, vitamin C and D help in providing essential nutrients to bones for proper healing.
• Ayurvedic massage with medicated oils like Mahanarayan Taila helps to reduce inflammation and improve blood circulation in the affected area.
• Cold compresses can be done to reduce the swelling, pain and inflammation caused due to Salter Harris fracture.

• Adequate protein intake: Eating foods that are rich in protein such as lean meats, fish, poultry, beans, and nuts can help aid in the healing process of a Salter Harris fracture.
• Calcium-rich foods: To help with bone density and strength, it is recommended to eat foods that are high in calcium such as dairy products, dark leafy greens, sesame seeds, and legumes.
• Vitamin C-rich foods: Vitamin C helps to support collagen formation which is necessary for the repair of damaged tissue. Fruits and vegetables like oranges, kiwis, peppers, broccoli, and spinach are great sources of vitamin C for patients suffering from a Salter Harris fracture.
• Vitamin D-rich foods: Vitamin D helps to regulate calcium levels which is crucial for healthy bones and can be found in fatty fish such as salmon or tuna or fortified milk alternatives like almond or soy milk.
• Essential fatty acids: Eating healthy fats such as avocados and olive oil can help fight inflammation which is associated with fractures.

• Unfamiliar or undercooked foods: Eating unfamiliar or undercooked foods can increase the risk of food-borne illnesses, which can weaken bones and delay bone healing.
• High fat and processed foods: Foods high in fat and processed ingredients can cause inflammation in the body, which can impair bone healing and potentially lead to further complications.
• High sodium foods: Too much salt in your diet can increase fluid retention, resulting in swelling that may interfere with the healing process.
• Sugary snacks and energy drinks: Sugar causes a release of insulin into the bloodstream, creating an inflammatory response that slows down healing time. Energy drinks also contain high levels of sugar as well as caffeine, which can lead to dehydration, fatigue and stress on bones during recovery from a Salter-Harris fracture.
• Caffeine beverages: Caffeine is a diuretic, meaning it increases urination frequency, leading to dehydration which can slow down the bone healing process during recovery from a Salter Harris fracture

• Closed Reduction: This is a non-surgical method of repositioning the fracture fragments to restore the normal anatomical alignment of the bone.
• Open Reduction: This is a surgical procedure where an incision is made to reduce and stabilise the fracture fragments using metal implants, such as pins and screws.
• Immobilisation: This involves using splints, casts, braces or slings to restrict movement of the affected limb and allow healing to take place.
• Physical Therapy: After reduction and immobilisation, physical therapy can help increase range of motion, build strength and improve function.
• Osteotomy: Surgery to cut through and reshape a bone or bones, to improve alignment and stability of the fracture.
• Internal Fixation: Insertion of screws, plates and/or pins inside the body to stabilise the fracture during the healing process.
• External Fixation: Use of rigid frame outside of the body to hold and stabilise the fracturing bones in proper alignment while they heal.
• Soft Tissue Repair: Repairing any torn soft tissues around fractured areas such as muscles, tendons, ligament, cartilage or joint capsule etc.

An orthopaedic doctor or paediatric orthopaedic specialist should be consulted if a child has sustained a Salter Harris fracture.

• Analgesics: Analgesics, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), can be used to reduce pain related to a Salter Harris fracture.
• Anti-inflammatories: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium or celecoxib, can help reduce inflammation associated with the fracture.
• Muscle relaxants: Muscle relaxants, such as cyclobenzaprine (Flexeril), can be used to reduce muscle spasms around the injured site and provide relief from pain.
• Corticosteroids: Corticosteroids may be administered by injection directly into the fracture site in order to reduce swelling and promote healing of the fracture area.
• Bisphosphonates: Bisphosphonates are used to improve mineral metabolism in order to enhance healing of the fracture area and prevent osteoporosis due to calcium loss from immobilisation following a Salter Harris fracture.

Generally, recovery time for a Salter Harris Fracture depends on the severity and type of fracture, as well as other factors such as age, health and fitness. In most cases, healing of the fracture may be expected to take about 6-8 weeks for non-displaced fractures and 4-6 months for displaced fractures.

Generally, patients will pay an average of Rs. 10,000 to Rs. 25,000 for the initial consultation and basic X-rays, while costs for more advanced imaging tests such as CT scans or MRI scans can cost anywhere from Rs. 8,000 to around Rs. 20,000.Surgery if required may then range anywhere between Rs. 20,000 to around Rs. 80,000 depending on severity and type of surgery needed.

Post-operative physical therapy could range anywhere from Rs 500 -Rs 3000 depending on duration and type of exercises prescribed by the doctor.Overall cost could range from a minimum of upto Rs 10500 -95000+.

The main side effects of Salter Harris Fracture treatments are:

• Pain: the fracture may cause pain, swelling and tenderness in the affected area.
• Numbness and tingling: due to the compression of nerve endings by the fracture, patients may experience numbness or tingling in the area.
• Infection: if not treated properly, there is a risk of infection at the fracture site.
• Limited range of motion: due to the stiffness caused by scar tissue formation, patients may experience limited range of motion in the affected area.
• Risk of non-union: if not treated properly, there is a risk that the fracture will not heal properly and result in a non-union or false joint.

Salter Harris Fracture is a type of fracture of the bones in the body. It is most commonly seen in children and teenagers, and it is one of the most common fractures. It occurs when there is a disruption in the growth plate at the end of a long bone due to trauma or injury. Treatment typically involves immobilisation and/or surgery to ensure proper healing.