Salter-Harris classification

Last revised by Andrew Murphy on 30 Jan 2023

The Salter-Harris classification was proposed by Salter and Harris in 1963 1 and, at the time of writing (January 2023) 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 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

    • 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

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