Salter–Harris fracture

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Salter–Harris fracture_table_infobox_0

Salter–Harris fracturesSalter–Harris fracture_header_cell_0_0_0
Other namesSalter–Harris fracture_header_cell_0_1_0 Growth plate fractureSalter–Harris fracture_cell_0_1_1
SpecialtySalter–Harris fracture_header_cell_0_2_0 Orthopedic surgery Q1711733?uselang=en#P1995Salter–Harris fracture_cell_0_2_1

A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. Salter–Harris fracture_sentence_0

It is thus a form of child bone fracture. Salter–Harris fracture_sentence_1

It is a common injury found in children, occurring in 15% of childhood long bone fractures. Salter–Harris fracture_sentence_2

This type of fracture and its classification system is named for Robert B. Salter and William H. Harris, who created and published this classification system in the Journal of Bone and Joint Surgery in 1963. Salter–Harris fracture_sentence_3

Types Salter–Harris fracture_section_0

There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963, and the rarer types VI to IX which have been added subsequently: Salter–Harris fracture_sentence_4

Salter–Harris fracture_unordered_list_0

  • Type I – transverse fracture through the growth plate (also referred to as the "physis"): 6% incidenceSalter–Harris fracture_item_0_0
  • Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis: 75% incidence, takes approximately 12-90 weeks or more in the spine to heal.Salter–Harris fracture_item_0_1
  • Type III – A fracture through growth plate and epiphysis, sparing the metaphysis: 8% incidenceSalter–Harris fracture_item_0_2
  • Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis: 10% incidenceSalter–Harris fracture_item_0_3
  • 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): 1% incidenceSalter–Harris fracture_item_0_4
  • 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)Salter–Harris fracture_item_0_5
  • Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)Salter–Harris fracture_item_0_6
  • Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossificationSalter–Harris fracture_item_0_7
  • Type IX – Injury of the periosteum which may impair intramembranous ossificationSalter–Harris fracture_item_0_8

SALTER mnemonic for classification Salter–Harris fracture_section_1

The mnemonic "SALTER" can be used to help remember the first five types. Salter–Harris fracture_sentence_5

N.B. Salter–Harris fracture_sentence_6

This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base. Salter–Harris fracture_sentence_7

Salter–Harris fracture_unordered_list_1

  • I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)Salter–Harris fracture_item_1_9
  • II – A = Above. The fracture lies above the physis, or Away from the joint.Salter–Harris fracture_item_1_10
  • III – L = Lower. The fracture is below the physis in the epiphysis.Salter–Harris fracture_item_1_11
  • IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.Salter–Harris fracture_item_1_12
  • V – R = Rammed (crushed). The physis has been crushed.Salter–Harris fracture_item_1_13

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'. Salter–Harris fracture_sentence_8

Prognosis Salter–Harris fracture_section_2

Fractures in children generally heal relatively fast, but may take several weeks to heal. Salter–Harris fracture_sentence_9

Most growth plate fractures heal without any lasting effects. Salter–Harris fracture_sentence_10

Rarely, bridging bone may form across the fracture, causing stunted growth and/or curving. Salter–Harris fracture_sentence_11

In such cases, the bridging bone may need to be surgically removed. Salter–Harris fracture_sentence_12

A growth plate fracture may also stimulate growth, causing a longer bone than the corresponding bone on the other side. Salter–Harris fracture_sentence_13

Therefore, the American Academy of Orthopaedic Surgeons recommends regular follow-up for at least a year after a growth plate fracture. Salter–Harris fracture_sentence_14

Additional images Salter–Harris fracture_section_3

See also Salter–Harris fracture_section_4

Salter–Harris fracture_unordered_list_2

Credits to the contents of this page go to the authors of the corresponding Wikipedia page:–Harris fracture.