Classification of Growth Plate Injuries
The Salter and Harris classification of growth plate injuries is commonly
used to describe injuries to the growth plate.
The Salter 1 injury is a nondisplaced
fracture. The x-ray is often normal, and according to traditional orthopedic
teaching this can cause the examining practitioner to miss the diagnosis. The
diagnosis should be based on clinical findings of point tenderness over the
epiphyseal area.3 The typical treatment for type 1 epiphyseal injuries usually
consists of immobilization and gradual return to play.
Types 1 and 2 have excellent
prognoses for prompt healing and no residual problems or growth disturbance.
3 and 4 require open reduction and internal fixation (surgery) and have a more
Type 5 can go unrecognized and has the potential to lead
to major growth disturbances.4
Because of the risk of injury to the epiphyseal
growth plates, x-rays are more often utilized in young athletic injuries. Even
what appears to be a mild ligament sprain,
will probably be x-rayed to make sure a growth plate fracture has not occurred.
The traditional orthopedic surgeon's recommendation for a young athlete with
a normal x-ray and palpatory tenderness is rest. Rest is tremendously detrimental
not only to the ligaments and tendons, but also to articular cartilage. Diminished
weight-bearing has been shown to lead to degeneration of the articular cartilage.5
It appears that sufficient loading (weight-bearing) is necessary for maintaining
healthy articular cartilage growth.6 Activity and cyclic loading are also necessary
to maintain the biochemical and structural integrity of ligaments and tendons.7
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