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Growth plate fractures — the Salter-Harris classification
In children the growth plate (physis) is weaker than ligaments and bone, so injury causes a fracture through it; the Salter-Harris classification predicts the risk of growth disturbance and tells you whether anatomic reduction is needed.
Why it matters in the exam
Questions show a radiograph or describe a fracture near a joint in a child and ask for the Salter-Harris type and the treatment. Type II is the most common (about 75%), while types III and IV cross the joint surface and need anatomic reduction, usually surgical. Type V is a crush of the plate that may not show on the first radiograph and appears only later as growth arrest. A ligament sprain is relatively rare in a young child: tenderness over the plate with a normal radiograph is treated as a type I fracture. Also remember to consider abuse when the mechanism does not fit. The risk of growth disturbance depends not only on the type but also on site and age: plates that provide much of the growth, such as the distal femur and proximal tibia, are especially sensitive, and the younger the child, the more growth remains and the larger any deformity from a bony bar will be. On the other hand, a young child can remodel an imperfect angle, mainly in the plane of motion of the nearby joint, so not every displacement needs reduction. A special case is the transitional fracture (Tillaux and triplane) of the adolescent ankle, where the plate closes unevenly and the fracture behaves like type III or IV and needs CT for planning. For any growth plate fracture, clinical and radiographic follow-up for about one year allows early detection and correction of growth arrest. When documenting and explaining to parents, state the risk of growth disturbance and the need for follow-up in advance, even when the fracture looks minor.
Key points
- The growth plate is the weak link in a child's skeleton.
- Type II is the most common (about 75%).
- Types III and IV are intra-articular and need anatomic reduction.
- Type V is a crush with a poor prognosis, often diagnosed in hindsight.
- Follow growth after fractures through high-risk plates.
Summary table
| Type | Course of the fracture line | Prognosis and treatment |
|---|---|---|
| I | Through the growth plate only (separation) | Good prognosis; cast, radiograph may look normal |
| II | Through the plate and out through the metaphysis | Most common; closed reduction and cast, good prognosis |
| III | Through the plate and out through the epiphysis into the joint | Intra-articular; anatomic reduction, usually surgical |
| IV | Across metaphysis, plate and epiphysis | Intra-articular; internal fixation, risk of a physeal bar |
| V | Crush of the plate | Poor prognosis; often diagnosed only later as growth arrest |
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Sources
- Rockwood and Wilkins' Fractures in Children, 9th ed. (2019) — Physeal Injuries
- Apley and Solomon's System of Orthopaedics and Trauma, 10th ed. (2017) — Injuries of the Growth Plate (Children's Fractures)
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.