Pediatric Radiology > Musculoskeletal > Trauma > Salter-Harris Fractures

Salter-Harris Fractures

The physeal plate is often involved in traumatic pediatric injuries. Up to one-third of all pediatric fractures involving the long bones will involve the physis. These fractures carry added significance because involvement of the "growth plate" may lead to arrested development of the affected limb. The more severe the injury, the higher the likelihood of requiring surgery with internal fixation.

The standard classification for physeal fractures was set forth by Salter and Harris. This classification divides fractures into five types based on whether the metaphysis, physis or epiphysis is involved as demonstrated radiographically.

Salter-Harris Fracture Classification Description
Type I fracture through the physeal plate (often not detected radiographically)
Type II fracture through the metaphysis and physis (most common; up to 75% of all physeal fractures)
Type III fracture through the epiphysis and physis
Type IV fracture through the metaphysis, physis and epiphysis
Type V crush injury involving part or all of the physis



Salter-Harris Type I fracture of tibial physis in a 10-year-old girl. AP (left) and lateral (right) radiographs of right ankle demonstrate a widened tibial physis. On the AP view, note the periosteal reaction on the medial aspect of the distal tibial metaphysis.
Salter-Harris Type II fracture of the left distal tibia. AP radiograph of tibia shows a fracture-dislocation of the tibial physis with a fracture through the metaphysis. Note the associated comminuted fracture of the distal fibula.  
Salter-Harris Type II Fracture of distal radius. Oblique (left) and lateral (right) radiographs demonstrate a fracture of the radial physis with involvement of the metaphysis. Note the fracture fragment (arrowhead) which is displaced dorsally on the lateral image.
Salter-Harris III fracture of distal tibial epiphysis in an 11-year-old boy. There is a vertical fracture through the medial portion of the distal tibial epiphysis.  
Salter-Harris IV fracture of the thumb. Two views of the left thumb reveal a fracture at the base of the proximal phalanx (arrows), involving the metaphysis, physis, and epiphysis.


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