Diagnosis of Salter-Harris I Fractures Is Difficult in the ED

In a retrospective chart review, researchers assessed outcomes in children who presented to a pediatric emergency department (ED) with distal fibular physis pain after trauma without evident fractures and were referred to orthopedic surgeons. Patients were included if they had open growth plates, normal 3-view ankle radiographs (read by an attending radiologist), and orthopedic follow-up.

Of 247 patients (mean age, 11 years), 165 (67%) were evaluated by general pediatricians in the ED and the rest by pediatric emergency physicians. Most patients (98%) were seen at an orthopedic clinic within 10 days. With the orthopedic surgeon's diagnosis considered the gold standard, emergency providers were significantly more likely to diagnose Salter-Har…