Salter-Harris classification

The Salter-Harris classification was proposed by Salter and Harris in 1963 ¹ and at the time or writing (June 2016) remains the most widely used 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 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
  • 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 which 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

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