The Salter-Harris Classification System Since the 1960's, the Salter-Harris classification, which divides most growth plate fractures into five categories based on the type of damage, has been the standard. The categories are as follows:
The Salter-Harris Classification of Growth Plate Injuries*
* Adapted from Disorders and Injuries of the Musculoskeletal System, 3rd Edition. Robert B. Salter, Baltimore, Williams and Wilkins, 1999. Used with the author's permission.For an image of the Salter-Harris fracture patterns, the NIH has information about growth plate injury types.
Type I
The epiphysis is completely separated from the end of the bone, or the metaphysis. The vital portions of the growth plate remain attached to the epiphysis. Only rarely will the doctor have to put the fracture back into place, but all type I injuries generally require a cast to keep the fracture in place as it heals. Unless there is damage to the blood supply, the likelihood that the bone will grow normally is excellent.
Type II
This is the most common type of growth plate fracture. The epiphysis, together with the growth plate, is partially separated from the metaphysis, which is cracked. Unlike type I fractures, type II fractures typically have to be put back into place and immobilized for normal growth to continue. Because these fractures usually return to their normal shape during growth, sometimes the doctor does not have to manipulate this fracture back into position.
Type III
This fracture occurs only rarely, usually at the lower end of the tibia, one of the long bones of the lower leg. It happens when a fracture runs completely through the epiphysis and separates part of the epiphysis and growth plate from the metaphysis. Surgery is sometimes necessary to restore the joint surface to normal. The outlook or prognosis for growth is good if the blood supply to the separated portion of the epiphysis is still intact, if the fracture is not displaced, and if a bridge of new bone has not formed at the site of the fracture.
Type IV
This fracture runs through the epiphysis, across the growth plate, and into the metaphysis. Surgery is needed to restore the joint surface to normal and to perfectly align the growth plate. Unless perfect alignment is achieved and maintained during healing, prognosis for growth is poor. This injury occurs most commonly at the end of the humerus (the upper arm bone) near the elbow.
Type V
This uncommon injury occurs when the end of the bone is crushed and the growth plate is compressed. It is most likely to occur at the knee or ankle. Prognosis is poor, since premature stunting of growth is almost inevitable.
A newer classification, called the Peterson classification, adds a type VI fracture, in which a portion of the epiphysis, growth plate, and metaphysis is missing. This usually occurs with an open wound or compound fracture, often involving lawnmowers, farm machinery, snowmobiles, or gunshot wounds. All type VI fractures require surgery, and most will require later reconstructive or corrective surgery. Bone growth is almost always stunted.
This content is copied from the NIH, for the page of origin, go to:
NIH Growth Plate Fractures
Updated: October 2001
