Salter-Harris classification

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