This patient fell off a second story balcony ontoher feet. The radiographs show several fractures within the body of the calcaneus. A Salter-Harris type V injury of the distal tibia was suspected because of the mechanism of injury. However, this type of injury is rarely visible on initial radiographs. The injury must be suspected clinically. Subsequent growth arrest of this area confirms the presence of the Salter-Harris type V injury.

Comparison views of the non-affected extremity may assist in radiographically diagnosing a SH-V type injury at initial presentation. Based on this comparison view, differences in the width of the growth plates may be evident. A complete obliteration or diminished physeal distance of the affected extremity confirms the diagnosis of a SH-V injury. However, even if there are no obvious differences on the comparison view, or if a comparison view is not obtained, or if both extremities are injured, the patient should be treated as a possible SH-V injury if the mechanism of injury suggests an axial compression along the long axis of the bone, and the patient exhibits tenderness along the physeal region.

1. Bachman D, Santora S. Orthopedic Trauma.In: Fleisher GR, Ludwid S (eds). Textbook ofPediatric Emergency Medicine, third edition.Baltimore, MD, Williams and Wilkins, 1993, pp. 1237-1238.

Copyrighted:Radiology Cases in Pediatric Emergency Medicine Volume 1, Case 18 Loren Yamamoto, MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns School of Medicine loreny@hawaii.edu

Last created on 12-06-2001
Last modified on 01-07-2006