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tvpjournal.com | July/August 2015 | TodAy's VeTerinAry PrAcTice A PrAcTiTioner's Guide To FrAcTure MAnAGeMenT Peer reviewed 21 Salter Harris Fractures Salter Harris fractures (SH) are growth plate (physeal) fractures in immature animals. They are classifed based on the prognosis for continued physeal growth (with type I less likely and type VI more likely to have long-term effects on mature bone length): ` SH I fracture: Involves a fracture through the physis itself ( Figure 6 ) ` SH II fracture: Involves the physis and extends into the metaphysis ` SH III fracture: Involves the physis and extends into the epiphysis; considered an intra-articular fracture ` SH IV fracture: Involves the physis and extends into both the metaphysis and epiphysis; considered an intra-articular fracture ` SH V fracture: Compression fracture through the physis ` SH VI fracture: Compression fracture through only a portion of the physis that typically results in angulation deformities after maturity. FIGURe 6. Salter Harris I fracture of the proximal right humeral growth plate. • Type II: > 1 cm puncture; external trauma • Type III: Extensive wound; soft tissues damaged or absent. Further classified as: » Type IIIa: Adequate skin to close the wound » Type IIIb: Insuffcient skin to close ("degloving injury") » Type IIIc: Compromised vascular supply to the skin. In summary, fracture classifcation provides an accurate description that is important when determining fxation approach (Table 2). For example, the fracture in Figure 7 (page 22) is classifed as a right closed mid-diaphyseal comminuted femoral fracture; there are multiple pieces but, in general, caudoproximal and medial displacement are present. FIXATION FACTORS Several options exist for fracture stabilization, and several factors must be considered when deciding on an appropriate fxation method: • Patient factors: Size, age, weight, breed, activity level • Client factors: Finances, compliance, husbandry Table 2. Fracture Classifcation 1. Bone 2. Location Articular, physeal, epiphyseal, metaphyseal, diaphyseal Subclassifcation: Condylar, supracondylar, trochanteric, subtrochanteric 3. Confguration Severity: Incomplete, complete, comminuted, segmental Pattern: Transverse, oblique (short or long), spiral, avulsion (enthesis or apophysis), growth plate 4. Displacement 5. Contamination Closed, open Subclassifcation of open: Type I, type II, type III FIGURe 5. An olecranon fracture is an example of an apophysis fracture. In this radiograph, the pull of the triceps is causing proximal displacement of the fracture fragment (arrow). Fixation for this fracture would involve counteracting the force of the triceps, such as a tension band fxation.