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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Arm injury. Fracture of proximal humerus. What type of salter harris fracture?

I am looking for the standard of care when an 8 month old infant presents with arm injury(rolled off couch onto hard wood floor).able to flex arm at elbow but obvious pain when arm extended over head. Initial xrays appear to identify a fracture of the proximal humerus ,but subsequent analysis seems to refute the diagnosis. Patient released from ER with prescription for pain meds. Follow up visit with peds and doctor still believes arm is broken and more xrays. Still no evidence of fracture after one week. Child is now using arm more and is in minimal pain.beginning to crawl.Sent to orthopedic specialist and seen by a PA.The PA wants to take more xrays,but the child has had about 5 sets in 2 weeks.That option is refused but the parents of the child suggest alternative test such as CT or MRI. Doctor declines and says she will wait for the results of skeletal survey ordered by CPS who became involved with the case because of the location of the fracture. CPS claims the the result of the skeletal survey show a growth plate fracture.They do not identify what type salter harris fracture it is.The specialist says she is not sure,and the xrays looks fuzzy and wants to do an MRI. This is 3 weeks post injury and the child is doing well and using the arm normally. Is this the standard of care? Is 3 weeks post injury a good time to evaluate a salter harris fracture?
Fri, 20 Jun 2014
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Orthopaedic Surgeon 's  Response
Hello.
Thanks for writing to us.
The type of fracture can be detected only after a direct examination and after checking the X-rays and MRI scan report. It is difficult to diagnose online.
I hope this information has been both informative and helpful for you.
Regards,
Dr. Praveen Tayal ,
drtayal72@gmail.com
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Arm injury. Fracture of proximal humerus. What type of salter harris fracture?

Hello. Thanks for writing to us. The type of fracture can be detected only after a direct examination and after checking the X-rays and MRI scan report. It is difficult to diagnose online. I hope this information has been both informative and helpful for you. Regards, Dr. Praveen Tayal , drtayal72@gmail.com