Salter-Harris Classification

Fig 1a: Type I transverse fracture

Fig 1b: Slipped Upper Femoral Epiphysis (SUFE) on the right in this case, which is a form of SH I injury

Fig 1c: A severe slip on the left

Type II

Type II – fracture through the physis with a detached triangular metaphyseal fragment. This is the most common type of physeal injury seen.

Fig 2a: Type II fracture through the physis with a detached triangular metaphyseal fragment

Fig 2b: SH II distal tibia

Type III – a fracture through the physis and then entering the joint through a fracture of the epiphysis. This is therefore an intra-articular fracture but it is very rare.

Fig 3a: Type III fracture through the physis and then entering the joint through a fracture of the epiphysis

Fig 3b: SH III distal tibia

Type IV – a fracture through the epiphysis, physis and metaphysis involving all three areas and being again intra-articular.

Fig 4a: Type IV fracture through the epiphysis, physis and metaphysis

Fig 4b: SH IV distal tibia

Type V – crush injury of the physis. There may be very little evidence of this on initial x-ray but the damaged physis means abnormal appearances months or years later as the bone growth has arrested. This is rare.

Fig 5: Type V crush injury of the physis

To help remember these different types use the S.A.L.T.R mnemonic:

1 = Slip

2 = Above the physis (through metaphysis)

3 = Lower than the physis (through epiphysis)

4 = Through (metaphysis, growth plate and epiphysis)

5 = Ram (a crushing type injury)

Fig 6: The Salter Harris classification of growth plate injuries.