Injuries leading to the bone fracture affecting the epiphyseal plate, or physis, are important and common in orthopedic medicine and the cause diagnostic and treatment challenges for orthopaedic surgeons. The related incidence rate of these fracture among pedicatric population is 15-20%.
Historical Perspective
In 1863, Foucher JT was the first person who described the injuries affecting the epiphyseal plate.
In 1895, Poland J, classified the injuries affecting the epiphyseal plat into the four types.
In 1936 , Aitken AP, defined the specific differences of different types of physes based on their differences in: structure, location, weightbearing status, and susceptibility to injury.
In 1963, two Canadian orthopaedic surgeons, Robert B. Salter (1924–2010) and W. Robert Harris (1922–2005), introduced a physeal fracture classification system according to the anatomy, fracture pattern, and prognosis of bone fracture.
Then, various researchers and physicians tried to expanded the original work of Salter and Harris in order to make it to be to be more comprehensive:
In 1968, Rang M, added a different sixth type of physeal injuries describing the caused damage to the perichondral ring due to the direct open injuries to the affected bone.
In 1981, Ogden JA, described nine types of injuries such as injuries affecting the developing bone’s other growth mechanisms.
Salter-Harris classification
Type
Descrpstion
Image
Radiography
Normal
Normal Bone
Type I
Frequency: 5-7%
cannot occur if the growth plate is fused cit
good prognosis
Mechanism: Fractured plane involved the whole growth plate, not involving bone
Origin: through the growth plate
Type 1-Salter-Harris classification
Salter-Harris type I injury of shoulder
Type II
Frequency: 75%
good prognosis
Mechanism: Fractured plane involved most of the growth plate and up through the metaphysis
Origin: through the growth plate and the metaphysis, sparing the epiphysis
Type 2 Salter-Harris classification
Salter-Harris type II injury of ankle
Type III
Frequency: 7-10%
cannot occur if the growth plate is fused cit
poorer prognosis as the proliferative and reserve zones are interrupted
Mechanism: Fractured plane involved the growth plate through the epiphysis
Origin: through growth plate and epiphysis, sparing the metaphysis
Type 3 Salter-Harris classification
Salter-Harris type III injury of ankle
Type IV
Frequency: 10%
cannot occur intra-articular
poor prognosis as the proliferative and reserve zones are interrupted
Mechanism: Fractured plane involved directly through the metaphysis, growth plate and down through the epiphysis
Origin: through all three elements of the bone, the growth plate, metaphysis, and epiphysis
Type 4- Salter-Harris classification
Salter-Harris type III injury of foot
Type V
Frequency: <1%
cannot occur if the growth plate is fused cit
worst prognosis
Mechanism: Fractured plane dose note involved the growth plate but damages it by direct compression
Origin: decrease in the perceived space between the epiphysis and metaphysis
Type 5 Salter-Harris classification
Rare Types: Type VI
An isolated damage of the perichondral structures
Rare Types: Type VII
An isolated damage of the epiphyseal plate
Rare Types: Type VIII
An isolated damage of the metaphysis, with a potential injury due to the endochondral ossification
Rare Types: Type IX
An isolated damage of the periosteum that may interfere with membranous growth plane
