Todd,
I got a real chuckle about your response below for its sheer veracity.
Thanx,
Frank Cunningham, M.D.
Children's Hospital @ St. Peter's University Hospital
New Brunswick, NJ
_____
From: Pediatric Emergency Medicine Discussion List on behalf of
[log in to unmask]
Sent: Sun 5/31/2009 8:34 PM
To: [log in to unmask]
Subject: Re: salter one fx
I call a Salter Harris 1 fracture if I have a pt. with open growth plates,
pain/tenderness over the growth plate with a history of trauma. I posterior
mold them and refer to PMD and to Ortho.
I clearly tell the parent when they follow up with the ortho that one of
two things WILL happen...
1. The pt. will follow up with ortho, the ortho will look at the xrays and
examine the area at question. If the pt. still has pain, the ortho will
likely tell you that the ER doc had no idea what they were talking about,
and
look, there is obviously a fracture there, just look at the x ray, see this
line? The ortho will than go on and charge for 6 weeks of follow up and
cast care.
OR
2. The pt. will follow up with ortho, look at the x rays and examine the
area in question. If the pt. has no more pain, the ortho will say, that ER
doc had no idea what they were talking about, there is obviously no fracture
there, see the x ray looks totally normal. see this nice line, a nice
looking growth plate.... Than they demand to have there bill waived for the
incorrect diagnosis from the ER.
FYI...from Textbook of Pediatric Emergency Medicine/Section IV:Trauma: page
1436:
"Salter-Harris Type I Fracture...........
........In General, when radiographic studies are negative but physical
findings are suggestive of a SH type I injury (e.g.,point tenderness over a
growth plate), immobilization and a follow up examination are essential."
-Todd Z
In a message dated 5/31/2009 4:41:36 P.M. Central Daylight Time,
[log in to unmask] writes:
How do you manage presumed salter one fractures? How do you, if you
do, confirm the dx? How do you advise and refer. For example,
suppose you have a 7 yo who injured left ankle the day before. There
is no swelling. She is more tender on the medial malleolus where is
suppose the growth plate is. There is very little if any swelling.
she walks on her tip toes and limps. the xray is normal. she will
not be able to get orthopedic follow up for a while ( 2 weeks). Do
you splint and crutch? How long do you advise this for?
don
sorry for the cross post but i think it is relevant to both and
responses may vary
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