SOAS EXAM 3 QUESTIONS AND
CORRECT ANSWERS
Salter Harris fractures: type two ANSW✅✅above
Separation through physis and metaphysis
Where is the most common location for a Salter-Harris type II fracture? ANSW✅✅Distal femur
Salter Harris fractures: type three ANSW✅✅lower
Articular fracture caused by separation through the epiphysis and physis
Where are salter-harris type III fractures usually found? ANSW✅✅Distal humerus
What is the least common type of salter-Harris fracture? ANSW✅✅Salter-harris III
Salter Harris fractures: type four ANSW✅✅through everything
Separation from epiphysis, physis, and metaphysis causing an articular fracture as well
Where are you most likely to see a Salter-Harris type IV fracture? ANSW✅✅Distal humerus
Salter Harris fractures: type five ANSW✅✅crush - physeal crushing injury
Where are you most likely to see a Salter-Harris type 5 fracture? ANSW✅✅Distal radius and ulna
What are the four regions of physeal anatomy? Describe them ANSW✅✅Reserved - metabolically
active, small
Proliferation - increase in number
Hypertrophy - increase in size
Calcification - maturation phase when cartilage turns into bone
,What is the weakest point of physeal transition zones? ANSW✅✅Hypertrophy
Salter Harris fractures: type one ANSW✅✅Straight across
--> separation through the physis
Where is the most common location for a Salter-Harris type I fracture? ANSW✅✅Slipped capital
physis of femur
Why is the most common site for physeal injury the radius and the ulna? ANSW✅✅Because its a
paired set of bones
Cone shape of distal ulnar physis
rapid growth rate
After a physeal fracture, what factors affect the degree of growth alteration ANSW✅✅Degree of
growth alteration depends on blood supply to the affected area, mechanical disruption, and growth
potential remaining
What is the Thurston-Holland sign? ANSW✅✅It is when the epiphysis is separated from the
physis with the fracture extending into the metaphysis. It makes a triangular fracture fragment.
In which type of Salter Harris fractures do you see a Thurston-Holland sign? ANSW✅✅Two and
four
How do you minimize surgical trauma during the repair of a Salter-Harris fracture? ANSW✅✅Use
pins instead of things like screws as this limits the trauma
Adaption osteosynthesis ANSW✅✅?? Ask Gina
Proximal humerus SH fractures are usually what type? ANSW✅✅type I
What are the surgical repairs for a salter-harris fracture of the proximal humerus? The prognosis?
ANSW✅✅repair with screws and maybe tension bands if necessary
Good prognosis
,How do you repair a proximal humerus SH fracture if the humeral head is completely fractures off?
ANSW✅✅Add Lag screw
Salter-Harris fractures of the distal humerus are typically where in it? What type of SH fracture are
they? ANSW✅✅Lateral aspect of the distal humeral condyle
IV
Why are spaniel breeds pre-disposed to having SH type 4 fractures of the distal humerus?
ANSW✅✅Cartilage defect in which they have incomplete ossification
How does jumping/ falling cause a fracture of the distal humerus? ANSW✅✅There is a transfer of
energy trough the radial head, this pushes on the condyle, causing the fracture
The radial head transmits ______% of weight to the distal humerus ANSW✅✅85%
What are the surgical repairs for a salter-Harris fracture of the distal humerus? The prognosis?
ANSW✅✅Reduce w/ clamp or bone reduction forceps...
Stabilize with transcondylar screw across epiphysis
Add in anti-rotational K wire
What are the surgical repairs for a salter-harris type I fracture of the distal radius? The prognosis?
ANSW✅✅cross pinning
Good
What type of SH fracture of the proximal femur are you most likely to see? ANSW✅✅SH type I
What are the surgical repairs for a salter-Harris fracture of the proximal femur? The prognosis?
ANSW✅✅Use divergent pinning, K wires, and pin placement
Fair to good due to blood supply considerations. Blood supply of the prox. femur comes from the
outside in and comes in around the neck of the femur
, In which salter-harris fracture do you see apple coring of the femoral neck? ANSW✅✅SH type I
Proximal femur neck
What kind of salter-Harris fractures usually affect the distal femur ANSW✅✅I or II
Discuss interdigitation in SH fractures of the distal femur ANSW✅✅Natural interdigitation
between segments due to 4 metaphyseal projections which fit into corresponding depressions in the
epiphysis
How do you repair a SH fracture of the distal femur? ANSW✅✅Reduction with leverage and
traction AKA reduce the epiphysis over top of the metaphysis
How do you place pins in a cross pinning technique for SH fractures of the distal femur?
ANSW✅✅Normograde pin placement starting proximal to the LDE tendon with the medial pin in
a corresponding position
These pins should cross on the metaphyseal side of the physis and penetrate the opposite cortex of
the bone
What kind of pins are used in a cross pinning technique for SH fractures of the distal femur? Where
should they cross? ANSW✅✅Cross on metaphyseal side of physis
Use K-wires or smaller pins
What kind of Salter-Harris fractures do you see of the proximal tibia? ANSW✅✅Type II of tibial
plateau
What do you repair SH fractures of the proximal tibia with? ANSW✅✅2-3 divergent K wires
What kind of Salter-Harris fractures do you see of the distal tibia? ANSW✅✅Salter-Harris I or II
What do you repair SH fractures of the distal tibia with? ANSW✅✅cross pin technique using K
wires starting from lateral and medial malleolus
CORRECT ANSWERS
Salter Harris fractures: type two ANSW✅✅above
Separation through physis and metaphysis
Where is the most common location for a Salter-Harris type II fracture? ANSW✅✅Distal femur
Salter Harris fractures: type three ANSW✅✅lower
Articular fracture caused by separation through the epiphysis and physis
Where are salter-harris type III fractures usually found? ANSW✅✅Distal humerus
What is the least common type of salter-Harris fracture? ANSW✅✅Salter-harris III
Salter Harris fractures: type four ANSW✅✅through everything
Separation from epiphysis, physis, and metaphysis causing an articular fracture as well
Where are you most likely to see a Salter-Harris type IV fracture? ANSW✅✅Distal humerus
Salter Harris fractures: type five ANSW✅✅crush - physeal crushing injury
Where are you most likely to see a Salter-Harris type 5 fracture? ANSW✅✅Distal radius and ulna
What are the four regions of physeal anatomy? Describe them ANSW✅✅Reserved - metabolically
active, small
Proliferation - increase in number
Hypertrophy - increase in size
Calcification - maturation phase when cartilage turns into bone
,What is the weakest point of physeal transition zones? ANSW✅✅Hypertrophy
Salter Harris fractures: type one ANSW✅✅Straight across
--> separation through the physis
Where is the most common location for a Salter-Harris type I fracture? ANSW✅✅Slipped capital
physis of femur
Why is the most common site for physeal injury the radius and the ulna? ANSW✅✅Because its a
paired set of bones
Cone shape of distal ulnar physis
rapid growth rate
After a physeal fracture, what factors affect the degree of growth alteration ANSW✅✅Degree of
growth alteration depends on blood supply to the affected area, mechanical disruption, and growth
potential remaining
What is the Thurston-Holland sign? ANSW✅✅It is when the epiphysis is separated from the
physis with the fracture extending into the metaphysis. It makes a triangular fracture fragment.
In which type of Salter Harris fractures do you see a Thurston-Holland sign? ANSW✅✅Two and
four
How do you minimize surgical trauma during the repair of a Salter-Harris fracture? ANSW✅✅Use
pins instead of things like screws as this limits the trauma
Adaption osteosynthesis ANSW✅✅?? Ask Gina
Proximal humerus SH fractures are usually what type? ANSW✅✅type I
What are the surgical repairs for a salter-harris fracture of the proximal humerus? The prognosis?
ANSW✅✅repair with screws and maybe tension bands if necessary
Good prognosis
,How do you repair a proximal humerus SH fracture if the humeral head is completely fractures off?
ANSW✅✅Add Lag screw
Salter-Harris fractures of the distal humerus are typically where in it? What type of SH fracture are
they? ANSW✅✅Lateral aspect of the distal humeral condyle
IV
Why are spaniel breeds pre-disposed to having SH type 4 fractures of the distal humerus?
ANSW✅✅Cartilage defect in which they have incomplete ossification
How does jumping/ falling cause a fracture of the distal humerus? ANSW✅✅There is a transfer of
energy trough the radial head, this pushes on the condyle, causing the fracture
The radial head transmits ______% of weight to the distal humerus ANSW✅✅85%
What are the surgical repairs for a salter-Harris fracture of the distal humerus? The prognosis?
ANSW✅✅Reduce w/ clamp or bone reduction forceps...
Stabilize with transcondylar screw across epiphysis
Add in anti-rotational K wire
What are the surgical repairs for a salter-harris type I fracture of the distal radius? The prognosis?
ANSW✅✅cross pinning
Good
What type of SH fracture of the proximal femur are you most likely to see? ANSW✅✅SH type I
What are the surgical repairs for a salter-Harris fracture of the proximal femur? The prognosis?
ANSW✅✅Use divergent pinning, K wires, and pin placement
Fair to good due to blood supply considerations. Blood supply of the prox. femur comes from the
outside in and comes in around the neck of the femur
, In which salter-harris fracture do you see apple coring of the femoral neck? ANSW✅✅SH type I
Proximal femur neck
What kind of salter-Harris fractures usually affect the distal femur ANSW✅✅I or II
Discuss interdigitation in SH fractures of the distal femur ANSW✅✅Natural interdigitation
between segments due to 4 metaphyseal projections which fit into corresponding depressions in the
epiphysis
How do you repair a SH fracture of the distal femur? ANSW✅✅Reduction with leverage and
traction AKA reduce the epiphysis over top of the metaphysis
How do you place pins in a cross pinning technique for SH fractures of the distal femur?
ANSW✅✅Normograde pin placement starting proximal to the LDE tendon with the medial pin in
a corresponding position
These pins should cross on the metaphyseal side of the physis and penetrate the opposite cortex of
the bone
What kind of pins are used in a cross pinning technique for SH fractures of the distal femur? Where
should they cross? ANSW✅✅Cross on metaphyseal side of physis
Use K-wires or smaller pins
What kind of Salter-Harris fractures do you see of the proximal tibia? ANSW✅✅Type II of tibial
plateau
What do you repair SH fractures of the proximal tibia with? ANSW✅✅2-3 divergent K wires
What kind of Salter-Harris fractures do you see of the distal tibia? ANSW✅✅Salter-Harris I or II
What do you repair SH fractures of the distal tibia with? ANSW✅✅cross pin technique using K
wires starting from lateral and medial malleolus
