Salter–Harris fracture

Salter–Harris fractures
An X-ray of the left ankle showing a Salter–Harris type III fracture of medial malleolus. Black arrow demonstrates fracture line while the white arrow marks the growth plate.
Classification and external resources
Specialty
eMedicine	radio/613 article/1260663, orthoped/627
Patient UK	Salter–Harris fracture

A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone. It is a common injury found in children, occurring in 15% of childhood long bone fractures.

Types

Salter Harris Fracture Types

There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963, and the rarer types VI to IX which have been added subsequently:

• Type I – transverse fracture through the growth plate (also referred to as the "physis"): 6% incidence
• Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis: 75% incidence, takes approximately 2–3 weeks to heal.
• Type III – A fracture through growth plate and epiphysis, sparing the metaphysis: 8% incidence
• Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis: 10% incidence
• Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray): 1% incidence
• Type VI – Injury to the peripheral portion of the physis and a resultant bony bridge formation which may produce an angular deformity (added in 1969 by Mercer Rang)
• Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)
• Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossification
• Type IX – Injury of the periosteum which may impair intramembranous ossification

SALTER mnemonic for classification

The mnemonic "SALTER" can be used to help remember the first five types. This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

• I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
• II – A = Above. The fracture lies above the physis, or Away from the joint.
• III – L = Lower. The fracture is below the physis in the epiphysis.
• IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
• V – R = Rammed (crushed). The physis has been crushed.

(alternatively SALTER can be used for the first 6 types - as above but adding Type V: 'E' for Everything or Epiphysis and Type VI:'R' for Ring)

Salter–Harris fracture images

Salter–Harris fracture radiographs with insets showing fracture lines.

Salter–Harris I fracture of distal radius. Salter–Harris I fracture of distal radius.  Salter–Harris II fracture of ring finger proximal phalanx. Salter–Harris II fracture of ring finger proximal phalanx.  Salter–Harris III fracture of big toe proximal phalanx. Salter–Harris III fracture of big toe proximal phalanx.  Salter–Harris IV fracture of big toe proximal phalanx. Salter–Harris IV fracture of big toe proximal phalanx.

See also

• Paul Jules Tillaux
• Thurstan Holland sign