Salter-Harris

Fractures
Chad Bevan
Radiology Clerkship
July 2006
 Overview
Salter-Harris fractures are fractures through a
growth plate (physis); therefore, they are unique
to pediatric patients.
Several types of fractures have been
categorized by the involvement of the physis,
metaphysis, and epiphysis.
The classification of the injury is important
because it affect the treatment of the patient and
provides clues to possible long-term
complications.
 Classifications
I
pure epiphyseal separation
if non-displaced, joint effusion may be only sign
II
metaphyseal fracture + epiphyseal separation
III
epiphyseal fracture
IV
vertically oriented fx thru epiphysis + metaphysis
V
crush injury of epiphysis (not detected acutely)
 Mnemonic

S Slipped
A Above
L Lower
T Through
(e)
R Raised

W. Robert Salter, MD
 Histologic Review
Important for
understanding prognosis
The germinal layer of the
cartilage is on the
epiphysis
Cartilage cells grow from
the epiphysis towards the
metaphysis. The
fragments of cells then
mineralize.
 Histology (contd)
Neovascularization occurs from the metaphysis
towards the epiphysis.
Damage to either epiphyseal or metaphyseal
vascular supply disrupts bone growth
Damage to the layer of cartilage may not be
significant if the surfaces are reapposed, and
vascular supply to the growing cartilage is not
permanently interrupted.
 Type I
A type 1 fracture is transverse fracture through
the hypertrophic zone of the physis. In this injury,
the width of the physis is increased. The growing
zone of the physis usually is not injured, and
growth disturbance is uncommon.
Usually dxd by clinical presentation alone.
On clinical examination, the child has point
tenderness at the epiphyseal plate, which is
suggestive of a type I fracture.
Example: SCFE
 Type II
A type II fracture is a fracture through the
physis and metaphysis, but the epiphysis
is not involved in the injury.
These fractures may cause minimal
shortening; however, the injuries rarely
result in functional limitations.
Type II is the most common Salter-Harris
fracture.
 Type III
A type III fracture is a fracture through the physis and the
epiphysis. This fracture passes across the hypertrophic
layer of the physis and extends to split the epiphysis,
inevitably damaging the reproductive layer of the
physis.
Prone to chronic disability because, by crossing the
physis, it extends into the articular surface of the bone.
Rarely result in significant deformity; therefore, they have
a relatively favorable prognosis.
A type of ankle fracture termed a Tillaux fracture is a type
of Salter-Harris type III fracture that is prone to disability.
Treatment is often surgical.
 Type IV
A Type IV fracture involves all 3 elements of the
bone: The fracture passes through the
epiphysis, physis, and metaphysis.
Similar to a type III fracture, a type IV fracture
also is an intraarticular fracture; thus, it can
result in chronic disability.
By interfering with the growing layer of cartilage
cells, these fractures can cause premature
focal fusion of the involved bone. Therefore,
these injuries can cause deformity of the joint.
 Type V
A type V injury is a compression or crush injury of the
epiphyseal plate with no associated epiphyseal or
metaphyseal fracture.
This fracture is associated with growth disturbances at
the physis. Initially, diagnosis may be difficult, and it often
is made retrospectively after premature closure of the
physis is observed. In the older teenagers, the diagnosis
is particularly difficult.
The clinical history is paramount in the diagnosis of this
fracture. A typical history is that of an axial load injury.
These injuries have a poor functional prognosis.
 Rare Salter-Harris Fractures
Type VI: This is a rare injury and consists of an
injury to the perichondral structures.
Type VII: This is an isolated injury to the
epiphyseal plate.
Type VIII: This is an isolated injury to the
metaphysis, with a potential injury related to
endochondral ossification.
Type IX: This is an injury to the periosteum that
may interfere with membranous growth.
 Final thoughts
Type II is most common
Types III & IV are more prone to chronic
disability
Type V associated with growth
disturbances and has a poor functional
prognosis
Only 2% of Salter-Harris fractures result in
a significant functional disturbance
 Special thanks to
www.pediatriconcall.com
www.fpnotebook.com
www.medicalmnemonics.com
www.emedicine.com
people breaking bones, who made this
presentation possible