UMEM Educational Pearls

Category: Orthopedics

Title: Pediatric Fractures and the Salter Harris System

Keywords: Salter Harris, pediatric, fracture (PubMed Search)

Posted: 1/16/2016 by Michael Bond, MD (Updated: 1/19/2016)
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The Salter Harris Classification System is used in pediatric epiphyseal fractures. The higher the type of fracture the greater the risk of complications and growth disturbance.

Some common exam facts about Salter Harris Fractures are:

  • The type II fracture is the most common.
  • The small metaphyseal fragment in Salter Harris type II and IV fractures is called the Thurston Holland Sign.
  • Type III and IV fractures often require open reduction and internal fixation due to the fracture extending into the joint.
  • Type V fractures may appear normal, but the epiphyseal plate is crushed and the blood supply is interrupted.

The Classification system as listed by Type:

  • Type I: A fracture through the physeal growth plate. Typically can not be seen on x-ray unless they growth plate is widened or displaced..
  • Type II: A fracture through the physeal growth plate and metaphysis.
  • Type III: A fracture through the physeal growth plate and epiphysis.
  • Type IV: A fracture through the epiphysis, physeal growth plate and metaphysis.
  • Type V: A crush injury of the physeal growth plate.

For Maite, a helpful mnemonic is SALTR , Slipped (Type I), Above (Type II), Lower (Type III), Through (Type IV), and Ruined or Rammed (Type V)

A image of the fractures can be found on FP Notebook at