The Salter-Harris classification was proposed by Salter and Harris in 1963 ¹ and is the most widely used (c. 2023) system for describing physeal fractures. 

Classification

Conveniently, the Salter-Harris types can be remembered by the mnemonic SALTR.

• type I

  • slipped

  • 5-7%

  • fracture plane passes all the way through the growth plate, not involving bone

  • cannot occur if the growth plate is fused ^cit

  • good prognosis

• type II

  • above

  • ~75% (by far the most common)

  • fracture passes across most of the growth plate and up through the metaphysis

  • good prognosis

• type III

  • lower

  • 7-10%

  • fracture plane passes some distance along with the growth plate and down through the epiphysis

  • poorer prognosis as the proliferative and reserve zones are interrupted

• type IV

  • through or transverse or together

  • intra-articular

  • 10%

  • fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis

  • poor prognosis as the proliferative and reserve zones are interrupted

• type V

  • ruined or rammed or crush

  • uncommon <1%

  • crushing type injury does not displace the growth plate but damages it by direct compression

  • worst prognosis

Others

There are a few other rare types that you should probably never include in a report, as almost no one will know what you are talking about. Nonetheless, they are:

• type VI:  injury to the perichondral structures

• type VII: isolated injury to the epiphyseal plate

• type VIII: isolated injury to the metaphysis, with a potential injury related to endochondral ossification

• type IX: injury to the periosteum that may interfere with membranous growth

Fractures that involve the physis can present with trapped periosteum and this should be considered when one aspect of the physis is widened ⁵.