Salter–Harris fracture

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Salter–Harris fractures
An X-ray of the left ankle showing a Salter–Harris type III fracture of medial malleolus. Black arrow demonstrates fracture line while the white arrow marks the growth plate.
Classification and external resources
eMedicine radio/613 article/1260663, orthoped/627

A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone. It is a common injury found in children, occurring in 15% of childhood long bone fractures.[1]


Salter Harris Fracture Types

There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963,[1] and the rarer types VI to IX which have been added subsequently:[2]

  • Type I – transverse fracture through the growth plate (also referred to as the "physis"):[3] 6% incidence
  • Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis:[4] 75% incidence, takes approximately 2–3 weeks or more in the spine to heal [5].
  • Type III – A fracture through growth plate and epiphysis, sparing the metaphysis:[6] 8% incidence
  • Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis:[7] 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):[8] 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)[9]
  • Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)[10]
  • Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossification
  • Type IX – Injury of the periosteum which may impair intramembranous ossification

SALTER mnemonic for classification[edit]

The mnemonic "SALTER" can be used to help remember the first five types.[11][12][13] 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)

Salter–Harris fracture images[edit]

Salter–Harris fracture radiographs with insets showing fracture lines.
Salter–Harris I fracture of distal radius
Salter–Harris II fracture of ring finger proximal phalanx
Salter–Harris III fracture of big toe proximal phalanx. 
Salter–Harris IV fracture of big toe proximal phalanx. 

See also[edit]


  1. ^ a b Salter RB, Harris WR (1963). "Injuries Involving the Epiphyseal Plate". J Bone Joint Surg Am. 45 (3): 587–622. Archived from the original on October 14, 2013. Retrieved October 13, 2013. 
  2. ^ Salter-Harris Fracture Imaging at eMedicine
  3. ^ "S.H. Type I – Wheeless' Textbook of Orthopaedics". September 13, 2011. Retrieved August 27, 2013. 
  4. ^ "S.H. Type II – Wheeless' Textbook of Orthopaedics". September 13, 2011. Retrieved August 27, 2013. 
  5. ^ Mirghasemi, Alireza; Mohamadi, Amin; Ara, Ali Majles; Gabaran, Narges Rahimi; Sadat, Mir Mostafa (November 2009). "Completely displaced S-1/S-2 growth plate fracture in an adolescent: case report and review of literature". Journal of Orthopaedic Trauma. 23 (10): 734–738. ISSN 1531-2291. PMID 19858983. doi:10.1097/BOT.0b013e3181a23d8b. 
  6. ^ "Salter Harris Type III Frx – Wheeless' Textbook of Orthopaedics". September 13, 2011. Retrieved August 27, 2013. 
  7. ^ "Salter Harris: Type IV – Wheeless' Textbook of Orthopaedics". September 13, 2011. Retrieved August 27, 2013. 
  8. ^ "Type V – Wheeless' Textbook of Orthopaedics". September 13, 2011. Retrieved August 27, 2013. 
  9. ^ Rang, Mercer, ed. (1968). The Growth Plate and Its Disorders. Harcourt Brace/Churchill Livingstone. ISBN 978-0-443-00568-8. 
  10. ^ Ogden, John A. (October 1, 1982). "Skeletal Growth Mechanism Injury Patterns". Journal of Pediatric Orthopaedics. 2 (4): 371–377. PMID 7142386. doi:10.1097/01241398-198210000-00004. 
  11. ^ Davis, Ryan (2006). Blueprints Radiology. ISBN 9781405104609. Retrieved March 3, 2008. 
  12. ^ "Salter-Harris Fractures". OrthoConsult. Retrieved 5 February 2017. 
  13. ^ Tidey, Brian. "Salter-Harris Fractures". Retrieved March 3, 2008.