A 14 yo M presents to the ED complaining of L knee pain. During a basketball game, he jumped for a lay up and upon landing had acute onset of pain. A plain film is shown below. What's the diagnosis? (scroll down for answer)

Answer: Salter Harris II fracture of L proximal tibia

• Salter Harris II: fracture line along physis and through metaphyseal bone
• Mechanism: hyperextension of knee
• Associated injuries: compartment syndrome, popliteal vessel injury
• Treatment:
• Closed reduction as needed, splint or cast, non-weight bearing
• Ice, elevate, analgesia
• Orthopedic follow up
• Possible long term complications: recurrent deformity, limb length discrepancy, growth arrest
• For review of other Salter Harris fracture types, check out this previous EM daily post here:  http://emdaily.cooperhealth.org/content/imaging-case-answer-5

References:

Bachman D, Santora S. “Musculoskeletal trauma”. Textbook of Pediatric Emergency Medicine. 2010

Arkader A, Skaggs DL. “Physeal Injuries”. Green’s Skeletal Trauma in Children. 2015

Black KJL, et al. “Musculoskeletal Disorders in Children”. Tintinalli’s Emergency Medicine: A comprehensive study guide, 8e. 2016