SALTER-HARRIS

FRACTURE
Alex Duckworth, MS4

What is a Salter-Harris fracture?

Fracture through growth plate in a pediatric

patient
35 % of skeletal injuries in patients aged 10-15
involve growth plate
Often due to trauma, usually sports-related or
fall
Complain of point tenderness around fracture
site
Soft-tissue swelling on physical exam

Anatomy of Long Bones

Epiphysis distal to the physis (growth
plate)

Metaphysis on opposite side of physis

from epiphysis

Diaphysis is long shaft beyond metaphysis

Normal Pediatric Long Bone

eMedicine Salter-Harris Fractures : Article by William

Moore, MD

Bone Growth
Cartilage growth from epiphysis towards

metaphysis
Neovascularization and primary bone formation
occurs from metaphysis towards epiphysis,
immature bone remodeled
Physis closes when vascular supplies of
metaphysis and epiphysis touch
Disruption of vasculature can cause growth
deformities
Classification of fractures impacts treatment
options and prognosis/complications

Overview of Classification

Adapted from Disorders and Injuries of the Musculoskeletal System, 3rd Edition. Robert
B. Salter, Baltimore, Williams and Wilkins, 1999.

Salter-Harris Type I (5%)

Transverse fracture through physis
Width of physis increased
Most critical part of growth plate usually
remains attached to epiphysis
Normally just casting while fracture heals
Good prognosis for normal growth

Salter-Harris Type I

eMedicine Salter-Harris
Fractures : Article by William
Moore, MD
http://radiology.creighton.edu/.../case6/index.htm

Salter-Harris Type I

http://members.aol.com/PTdoctor/
salter-harris.html

http://members.fortunecity.com/rad
rep/id36.htm

Salter-Harris Type II (75%)

Most common
Fracture through physis as well as
metaphysis
No epiphyseal involvement
Usually requires manipulation of fracture
back into position and immobilization for
normal growth

Salter-Harris Type II

eMedicine Salter-Harris
Fractures : Article by William
Moore, MD

www.mevis.de/~hhj/TraumaRad/TraumaRa
dHiRes.htm

Salter-Harris Type II

eMedicine Salter-Harris Fractures :

Article by William Moore, MD

www.uth.tmc.edu/radiology/test/er
_primer/shoulder/sh29.html

Salter-Harris Type III (10%)

Fracture involving physis and epiphysis
Usually causes damage to reproductive
part of physis
Chronic disability because of involvement
of articular surface
Commonly requires surgery
Good prognosis for normal growth if blood
supply not disrupted to epiphysis and
fracture non-displaced

Salter-Harris Type III

eMedicine Salter-Harris Fractures :

Article by William Moore, MD

http://www.hawaii.edu/medicine/pediat
rics/pemxray/v1c18.html

Salter-Harris Type III

http://members.fortunecity.com/radrep/id36.htm

Salter-Harris Type IV (10%)

Fracture through epiphysis, physis, and
metaphysis
Also chronic disability because of articular
surface involvement
Damage to growing cartilage can cause
premature fusion of bone
Surgery required to realign growth plate
Poor prognosis, high risk of growth
disturbance

Salter-Harris Type IV

eMedicine Salter-Harris
Fractures : Article by William
Moore, MD

http://xray.20m.com/photo4.html

Salter-Harris Type IV

http://members.fortunecity.com/radrep/id36.htm

Salter-Harris Type V (<1%)

Rare
Typical history of axial load
Crush injury of growth plate, no damage to
epiphysis or metaphysis
Poor prognosis, almost inevitable growth
disturbance
Diagnosis difficult, often made after
premature closure of growth plate seen

Salter-Harris Type V

eMedicine Salter-Harris Fractures :

Article by William Moore, MD
http://www.hawaii.edu/medicine/pedi
atrics/pemxray/v1c18.html

Salter-Harris Type V

http://members.fortunecity.com/radrep/id36.htm

Sources

http://www.hawaii.edu/medicine/pediatrics/pemxray/v1c18.html
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 18
Loren G. Yamamoto, MD, MPH
Stanley M.K. Chung, MD
Alson S. Inaba, MD
Kapiolani Medical Center For Women And Children
University of Hawaii John A. Burns School of Medicine

http://orthopedics.about.com/cs/generalinfo4/a/salterharris.htm
Salter-Harris Fracture Classification
Jonathan Cluett, MD

eMedicine Salter-Harris Fractures : Article by William Moore, MD