Signalment & History
- This patient presented after being hit by a car.
- On physical examination, his temperature is 103.5F, heart rate 132 beats per minute, and respiratory rate 60 beats per minute are elevated. He has deep lacerations of the right pelvic limb and swelling over the region of the left coxofemoral joint, severe soft tissue swelling around the left stifle and crepitus in the distal left femur.
Findings
There is focal increased soft tissue opacity within the right stifle joint, displacing the fat pad cranially and distally. Multifocal gas opacities are seen within the soft tissue structures of the mid- to distal right crus. Multiple open physes are seen. A well-defined, sharply marginated, complete, oblique fractures is identified within the left femoral capital physis and metaphysis. The medial portion of the femoral head is seen within the left acetabulum and the remainder of the left proximal femur is mildly craniodorsolaterally displaced relative to the capital fragment. Additionally, a well-defined, sharply marginated, complete, oblique fracture is identified within the left distal femur extending from the distal metaphysis through the distal femoral physis. There is moderate caudoproximomedial displacement of the most distal femoral fragment relative to the remainder of the proximal femur. A large amount of soft tissue opacity is seen within the left stifle joint. There is moderate to severe thickening of the soft tissue structures surrounding the coxofemoral and stifle regions.
Diagnosis
This patient is diagnosed with an acute Salter-Harris type II fracture of the left femoral head and of the distal femur with associated moderate to severe perilesional soft tissue swelling and stifle joint effusion and/or synovial proliferation. Considerations for moderate to severe perilesional soft tissue swelling include hemorrhage, edema, and/or cellulitis. Right stifle joint effusion and/or synovial proliferation. Soft tissue laceration of the distal right pelvic limb.
Conclusions
Salter-Harris Classification
- Type I: Physeal separation resulting in displacement of the epiphysis from the metaphysis at the growth plate.
- Type II: A corner of the metaphyseal bone is fractured with displacement of the epiphysis from the metaphysis at the growth plate.
- Type III: A fracture through the epiphysis and part of the growth plate; the metaphysis is unaffected (articular fractures).
- Type IV: A fracture through the epiphysis, growth plate, and metaphysis; several fracture lines may be seen (articular fractures).
- Type V: A compression fracture of the physis: These fractures can lead to premature closure of the physis resulting in abnormal growth and limb deformity. This is most commonly seen in the distal ulnar growth plate due to its conical morphology.
