Salter–Harris fracture

Salter–Harris fractures

An X-ray of the left ankle showing a Salter–Harris type III fracture of medial malleolus. Black arrow demonstrates fracture line while the white arrow marks the growth plate.
Classification and external resources
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A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone. It is a common injury found in children, occurring in 15% of childhood long bone fractures.^[1]

Types

Salter Harris Fracture Types

There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963,^[1] and the rarer types VI to IX which have been added subsequently:^[2]

Type I – transverse fracture through the growth plate (also referred to as the "physis"):^[3] 6% incidence
Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis:^[4] 75% incidence, takes approximately 2–3 weeks to heal.
Type III – A fracture through growth plate and epiphysis, sparing the metaphysis:^[5] 8% incidence
Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis:^[6] 10% incidence
Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray):^[7] 1% incidence
Type VI – Injury to the peripheral portion of the physis and a resultant bony bridge formation which may produce an angular deformity (added in 1969 by Mercer Rang)^[8]
Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)^[9]
Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossification
Type IX – Injury of the periosteum which may impair intramembranous ossification

SALTER mnemonic for classification

The mnemonic "SALTER" can be used to help remember the first five types.^[10]^[11]^[12] This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
II – A = Above. The fracture lies above the physis, or Away from the joint.
III – L = Lower. The fracture is below the physis in the epiphysis.
IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
V – R = Rammed (crushed). The physis has been crushed.

(alternatively SALTER can be used for the first 6 types – as above but adding Type V: 'E' for Everything or Epiphysis and Type VI:'R' for Ring)