0071643192.pdf

PEDIATRICS

TREATMENT

■ Supportive; NSAIDs for pain control

■ If Lyme arthritis, treat with oral doxycycline (if ( 8 years age) or amoxi-

cillin (if < 8 years age) for 21–28 days.

Fractures

SALTER-HARRISFRACTURES

The Salter-Harris classification is used for physeal injuries only (see Figure 5.21).

Type II fractures are the most common and, along with Type I, have the best

prognosis as the growth plate is not affected. Tenderness over a physis, even

with normal radiographs, should be treated as a Salter-Harris I fracture.

Salter-Harris type II is the

most common form of a

physeal fracture (75%).

Children with normal initial

radiographs may still have a

Salter I fracture; the presence

of pain and tenderness over a

growth plate should prompt

splinting and orthopedic

follow-up.

Femur

Metaphysis

Growth plate

(physis)

Fracture plane

Epiphysis

Tibia

FIGURE 5.21. Salter-Harris classification of fractures.

(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency

Medicine, 2nd ed. New York: McGraw-Hill, 2002:467.)

Salter-Harris

fractures—

SALTR

S(I) = Slipped epiphysis

A(II) = fracture Above

physis

L(III) = fracture beLow

physis

T(IV) = fracture Through

physis

R(V) = wRecked physis