A Salter–Harris fracture is a fracture that involves the

epiphyseal plate The epiphyseal plate, epiphysial plate, physis, or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with ma ...

(growth plate) of a bone, specifically the zone of provisional

calcification Calcification is the accumulation of calcium salts in a body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. D. Cardiovascular calcification: Orbicular origins. ''Nature M ...

. It is thus a form of child bone fracture. It is a common injury found in children, occurring in 15% of childhood long bone fractures. This type of fracture and its classification system is named for

Robert B. Salter Robert Bruce Salter (December 15, 1924 – May 10, 2010) was a Canadians, Canadian surgery, surgeon and a pioneer in the field of pediatric orthopaedic surgery. Born in Stratford, Ontario, he graduated in medicine from the University of Toronto i ...

and William H. Harris who created and published this classification system in the ''Journal of Bone and Joint Surgery'' in 1963.

Types

There are nine types of Salter–Harris fractures; types I to V as described by Robert B. Salter and William H. Harris in 1963, and the rarer types VI to IX which have been added subsequently: * Type I – transverse fracture through the

growth plate The epiphyseal plate, epiphysial plate, physis, or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with ma ...

(also referred to as the "

physis Physis (; ; pl. physeis, φύσεις) is a Greek philosophical, theological, and scientific term, usually translated into English—according to its Latin translation "natura"—as "nature". The term originated in ancient Greek philosophy, a ...

"): 6% incidence * Type II – A fracture through the growth plate and the

metaphysis The metaphysis (: metaphyses) is the neck portion of a long bone between the epiphysis and the diaphysis. It contains the growth plate, the part of the bone that grows during childhood, and as it grows it ossifies near the diaphysis and the ep ...

, sparing the

epiphysis An epiphysis (; : epiphyses) is one of the rounded ends or tips of a long bone that ossify from one or more secondary centers of ossification. Between the epiphysis and diaphysis (the long midsection of the long bone) lies the metaphysis, inc ...

: 75% incidence, takes approximately 12-90 weeks or more in the spine to heal. * Type III – A fracture through growth plate and epiphysis, sparing the metaphysis: 8% incidence * Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis: 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 An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

): 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) * Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden) * Type VIII – Isolated injury of the metaphysis with possible impairment of

endochondral ossification Endochondral ossification is one of the two essential pathways by which bone tissue is produced during fetal development and bone healing, bone repair of the mammalian skeleton, skeletal system, the other pathway being intramembranous ossificatio ...

* Type IX – Injury of the periosteum which may impair

intramembranous ossification Intramembranous ossification is one of the two essential processes during fetal development of the gnathostome (excluding chondrichthyans such as sharks) skeletal system by which rudimentary bone tissue is created. Intramembranous ossification i ...

SALTER mnemonic for classification

The mnemonic "SALTER" can be used to help remember the first five types. N.B.: 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'.

Prognosis

Fractures in children generally heal relatively fast but may take several weeks to heal. Last Reviewed: October 2014 Most growth plate fractures heal without any lasting effects. Rarely, bridging bone may form across the fracture, causing stunted growth and/or curving. In such cases, the bridging bone may need to be surgically removed. A growth plate fracture may also stimulate growth, causing a longer bone than the corresponding bone on the other side. Therefore, the

American Academy of Orthopaedic Surgeons The American Academy of Orthopaedic Surgeons (AAOS) is an orthopedic organization. Founded at Northwestern University in 1933, as of 2015 AAOS had grown to include about 39,000 members.AAOMembersPage accessed June 27, 2015 The group provides ed ...

recommends regular follow-up for at least a year after a growth plate fracture.

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References

External links