Salter-Harris Fracture  

Salter-Harris fracture is an injury to the

growth plate area of a child’s bone.
The growth plate is a soft area of cartilage at
the ends of long bones. These are bones that
are longer than they are wide. Salter-Harris
fractures can occur in any long bone, from
fingers and toes, to arm and leg bones.
A child’s bone growth occurs mainly in the
growth plates. When children are fully grown,
these areas harden into solid bone.
The growth plates are relatively weak and can
be injured by a fall, a collision, or excessive
pressure. Salter-Harris fractures make up 15 to
30 percentTrusted Source of bone injuries in
children. Most commonly these fractures
occur in children and teenagers during sports
activity. Boys are twice as likely as girls to
have a Salter-Harris fracture.
It’s important to diagnose and treat a Salter-
Harris fracture as soon as possible to ensure
normal bone growth.

What are the symptoms?

Salter-Harris fractures most often occur with a
fall or injury that causes pain. Other symptoms
include:
 tenderness near the area
 limited range of motion in the area,
especially with upper body injuries
 inability to bear weight on the affected
lower limb
 swelling and warmth around the joint
 possible bone displacement or deformity

Types of Salter-Harris fractures

Salter-Harris fractures were first categorized
in 1963 by Canadian doctors Robert Salter and
W. Robert Harris.
There are five main types, distinguished by the
way the injury impacts the growth plate and
surrounding bone. The higher numbers have
a higher riskTrusted Source of possible growth
problems.
The growth plate is known as the physis, from
the Greek word “to grow.” The growth plate is
located between the rounded top of the bone
and the bone shaft. The rounded bone edge is
called the epiphysis. The narrower part of the
bone is called the metaphysis.

Type 1
This fracture occurs when a force hits the
growth plate separating the rounded edge of
the bone from the bone shaft.
It’s more commonTrusted Source in younger
children. About 5 percentTrusted Source of
Salter-Harris fractures are type 1.

Type 2
This fracture occurs when the growth plate is
hit and splits away from the joint along with a
small piece of the bone shaft.
This is the most common Trusted Sourcetype
and happens most often in children over 10.
About 75 percentTrusted Source of Salter-
Harris fractures are type 2.

Type 3
This fracture occurs when a force hits the
growth plate and the rounded part of the bone,
but doesn’t involve the bone shaft. The
fracture may involve cartilage and enter into
the joint.
This type usually happens after age 10.
About 10 percent Trusted Sourceof Salter-
Harris fractures are type 3.

Type 4
This fracture occurs when a force hits the
growth plate, the rounded part of the bone, and
the bone shaft.
About 10 percentTrusted Source of Salter-
Harris fractures are type 4. This can happen at
any age, and it may affect bone growth.

Type 5
This uncommon fracture occurs when the
growth plate is crushed or compressed. The
knee and ankle are most often involved.
Fewer than 1 percent of Salter-Harris fractures
are type 5. It’s often misdiagnosed, and the
damage can interfere with bone growth.

Other types
Another four fracture types are extremely rare.
They include:
 Type 6 which affects connective tissue.
 Type 7 which affects the bone end.
 Type 8 which affects the bone shaft.
 Type 9 which affects the fibrous
membrane of the bone.

How is this diagnosed?

If you suspect a fracture, take your child to a
doctor or the emergency room. Prompt
treatment for growth plate fractures is
important.
The doctor will want to know how the injury
occurred, whether the child has had previous
fractures, and whether there was any pain in
the area before the injury.
They’ll likely order an X-ray of the area, and
possibly of the area above and below the
injury site. The doctor may also want an X-ray
of the unaffected side to compare them. If a
fracture is suspected but doesn’t show up in
the image, the doctor may use a cast or splint
to protect the area. A repeat X-ray in three or
four weeks can confirm the fracture diagnosis
by imaging new growth along the break area.
Other imaging tests may be needed if the
fracture is complex, or if the doctor needs a
more detailed view of soft tissue:
 A CT scan and possibly an MRI may be
useful for evaluating the fracture.
 CT scans are also used as a guide in
surgery.
 An ultrasound may be useful for imaging
in an infant.
Type 5 fractures are difficult to diagnose. A
widening of the growth plate may provide a
clue to this type of injury.

Treatment options
Treatment will depend on the type of Salter-
Harris fracture, the bone involved, and
whether the child has any additional injuries.

Nonsurgical treatment
Usually, types 1 and 2 are simpler and don’t
require surgery.
The doctor will put the affected bone in a cast,
splint, or sling to keep it in the right place and
protect it while it heals.
Sometimes these fractures may require
nonsurgical realignment of the bone, a process
called closed reduction. Your child may need
medication for pain and a local or possibly
general anesthetic for the reduction procedure.
Type 5 fractures are more difficult to diagnose
and are likely to affect proper bone growth.
The doctor may suggest keeping weight off
the affected bone, to make sure that the growth
plate isn’t damaged further. Sometimes the
doctor will wait to see how bone growth
develops before treatment.
Surgical treatment
Types 3 and 4 usuallyTrusted Source need a
surgical realignment of the bone, called open
reduction.
The surgeon will put the bone fragments into
alignment and may use implanted screws,
wires, or metal plates to hold them in place.
Some Type 5 fractures are treated with
surgery.
In surgery cases, a cast is used to protect and
immobilize the injured area while it heals.
Follow-up X-rays are needed to check on bone
growth at the injury site.

Recovery timeline
Recovery times vary, depending on the
location and severity of the injury. Usually,
these fractures heal in four to six weeks.
The length of time the injury remains
immobilized in a cast or sling depends on the
particular injury. Your child may need
crutches to get around, if the injured limb
shouldn’t be weight-bearing while it’s healing.
After the initial period of immobilization, the
doctor may prescribe physical therapy. This
will help your child regain flexibility, strength,
and range of motion for the injured area.
During the recovery period, the doctor may
order follow-up X-rays to check on healing,
bone alignment, and new bone growth. For
more serious fractures, they may want regular
follow-up visits for a year or until the child’s
bone is fully grown.
It may take time before your child can move
the injured area normally or resume sports. It’s
recommended that children with fractures
involving a joint wait four to six
monthsTrusted Source before participating in
contact sports again.