A 9-year-old boy falls from a height landing on his foot. Ankle radiographs immediately after injury appear essentially normal apart from soft tissue swelling. Two years later he has progressive shortening and varus deformity of that leg. The underlying injury was MOST likely:

• A Salter-Harris Type I physeal separation
• B Salter-Harris Type II fracture
• C Salter-Harris Type IV fracture
• D Salter-Harris Type V crush injury of the physis ✓

Explanation

Salter-Harris Type V is an axial compression crush of the physis. Initial radiographs are usually normal because there is no displaced fragment, and the diagnosis is often retrospective when premature partial physeal closure causes angular deformity and limb length discrepancy. It carries the worst prognosis of all Salter-Harris types. Types I and II have an excellent prognosis because the germinal layer is not injured.

Reference: Rockwood and Green's Fractures in Children, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.