Treatment of stubbed toe injuries with occult open fractures should include irrigation and debridement, chlorhexidine gluconate soaks, a course of oral antibiotic therapy, and fracture care. Physeal anatomy Salter-Harris classification of physeal injuries. Osteomyelitis has also been reported in patients with fractures of the distal phalanx of the finger, either occult or with associated fingernail avulsion, who did not receive prophylactic antibiotics.
Salter harris 2 fracture skin#
Any fracture of the physis is likely to extend through the adjacent skin to create an open fracture, with substantial risk of contamination of the wound in children who play barefoot. Type V fractures are compression injuries to the physis. Type IV fractures cross the epiphysis, physis, and metaphysis. Type III fractures are intra-articular fractures through the epiphysis that extend across the physis. The physeal plate is relatively unprotected. Type II fractures involve a break from the growth plate up into the metaphysis, with the periosteum usually remaining intact. At the root of the nail, the dermis of the skin is attached directly to the periosteum with no intervening subcutaneous tissue. Salter-Harris type II fractures of the proximal phalanges are the most prevalent physeal injuries in the hand 2. 1-3 The stubbing results in forceful hyperflexion of the great toe that causes fracture through the growth plate with flexion deformity.īleeding in or around the nail fold, at times in association with laceration proximal to the nail fold, suggests an open fracture. Such injuries are most common during the summer when children go barefoot and stub their toes on a shallow ridge, such as a sidewalk crack or tree stump that is cut near ground level. Stubbing injuries to the great toe can cause occult open fracture and subsequent osteomyelitis. Radiographs of the left foot revealed a Salter-Harris II fracture of the distal phalanx ( B). He presented with tenderness, swelling, and ecchymosis of the left great toe and bleeding in and around the nail fold ( A). Salter III (Lower): This is an intra-articular fracture extending. A 10-year-old boy stubbed his toe while running upstairs barefoot. Salter II (Above): These are when the fracture extends through both the physis and metaphysis.
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