Which Salter-Harris fracture types involve cartilage of both the articular surface and growth plate and usually require open reduction and internal fixation?

Which Salter-Harris fracture types involve cartilage of both the articular surface and growth plate and usually require open reduction and internal fixation?

• A. Type I
• B. Type II
• C. Types IV and V
• D. Types II and III

Answer: (C)

When thinking about Salter-Harris injuries, the key idea is how far the fracture goes through the growth plate (physis) and whether it also involves the joint surface (epiphysis). Intra-articular involvement makes the fracture much less stable and a poor candidate for simple, nonoperative reduction because any misalignment of the joint surface can lead to arthritis and growth problems. Fractures that cross the growth plate and the joint surface damage the cartilage of both structures. That combination means you need precise realignment to restore the joint surface and the growth plate, which is achieved best with open reduction and internal fixation. One pattern does this by running through the metaphysis, physis, and epiphysis, clearly involving the joint surface and the physis. The other pattern is a crush injury of the growth plate that can also disrupt the joint surface, again creating instability and an indication for surgical fixation when restoration of alignment is necessary. So, when a Salter-Harris injury involves cartilage of both the articular surface and the growth plate and is displaced or unstable, open reduction and internal fixation is typically required.

When thinking about Salter-Harris injuries, the key idea is how far the fracture goes through the growth plate (physis) and whether it also involves the joint surface (epiphysis). Intra-articular involvement makes the fracture much less stable and a poor candidate for simple, nonoperative reduction because any misalignment of the joint surface can lead to arthritis and growth problems.

Fractures that cross the growth plate and the joint surface damage the cartilage of both structures. That combination means you need precise realignment to restore the joint surface and the growth plate, which is achieved best with open reduction and internal fixation. One pattern does this by running through the metaphysis, physis, and epiphysis, clearly involving the joint surface and the physis. The other pattern is a crush injury of the growth plate that can also disrupt the joint surface, again creating instability and an indication for surgical fixation when restoration of alignment is necessary.

So, when a Salter-Harris injury involves cartilage of both the articular surface and the growth plate and is displaced or unstable, open reduction and internal fixation is typically required.