A 9 year old female presented to the emergency department after falling from a horse at summer camp and injuring her right wrist. She complained of pain with palpation and movement of the wrist. Examination revealed mild swelling and tenderness over the wrist, but plain films did not show any obvious abnormalities. Due to the possibility of a Salter Harris I fracture that may not be visible on initial x-rays, the patient was splinted and advised to follow up with orthopedics in 7-10 days for repeat films to check for any delayed findings.

2.  9 yo female presents c/o right
wrist pain after falling off of a
horse while at summer camp.
She complains of pain with
palpation and passive motion of
wrist. Ice was placed on injured
extremity at scene and she has
no other complaints.
 T:97.8F P:104 R:18 BP:104/78
O2:98%
 Gen: anxious but NAD
 HENT: no evid of trauma
 CV/Lungs:clear, mildly
tachycardic, RRR
 Abd: soft, NT, ND
 Ext: 2+ radial pulse with god cap
refill. Ulnar.Radial, Median
nerves intact to motor and
sensation. Mild swelling over
dorsum of right wrist, TTP, but
no obvious osseous abnormality.

4. E
P
M
D
No obvious
abnormality
is seen on
two views,
but pt
remains
tender on
exam.

5.  Solid neurovascular exam
 Plain films
 Analgesia
 If visible separation of epiphysis, will need
reduction
 If suspicion remains and x-rays appear normal,
splint and follow up with Ortho in 7 days for
repeat films.

6.  Salter Harris I is a fracture through the physis with
separation of epiphysis.
 Might not be readily visible on xray for up to one week
 Do not mistake injury as “sprain” when it is near a
growth plate.
 If unsure, splint and FU with orthopedics in 7-10 days
for repeat films.
 If treated correctly, complications are rare.

8.  http://www.feinberg.northwestern.edu/emergencyme
d/residency/ortho-
teaching/pediatrics/case23/case23edmanagement.htm
l
 http://www.hawaii.edu/medicine/pediatrics/pemxray/
v3c05.html
 http://rad.usuhs.edu/medpix/kiosk_image.html?imag
eid=21433&quiz=#pic
 Menkes, J.S. Orthopedic Injuries. Tintinalli’s
Emergency Medicine: A Comprehensive Study Guide
Chapter 267