Salter-Harris Classification of Epiphyseal Plate Injuries

Type I

More common in newborns and in young children in whom epiphyseal plate is relatively thick

Treat with closed reduction

Prognosis is good

Type II

Most common

Line of fracture-separation extends along the epiphyseal plate to a variable distance and then out through a portion of the metaphysis thereby producing a triangular shaped metaphyseal fragment

Mechanism: shear or avulsion with angular force

Usually w/ older children

Periosteum is torn on the convex side of the angulation but intact on the concave side

Closed reduction with stabilization

Prognosis is good

Type III

Fracture is intra-articular extends from the jt. surface to the deep zone of the epiphyseal plate and then along the plate to the periphery

Uncommon

Caused by Intraarticular shearing

tx is open reduction

Prognosis is good provided blood supply has not been disrupted

Type IV

Intraartiular fracture; extends from the jt. surface through the epiphysis across the ENTIRE thcikness of the eiphyseal plate and through a portion of the metaphysis

most common type IV is a fx of the lat. condyle of the humerus

treat with open reduction and internal fixation

Prognosis is BAD unless PERFECT reduction is both obtained and maintained - potentially interferes with normal growth

Type V

Relatively uncommon injury; if it occurs it is most common in the knee or ankle

Results from severe crushing force being applied through the epiphysis to one area of the epiphyseal plate; severe axial loading

Epiphysis NOT usually displaced

Avoid WB for 3 wks

Prognosis is POOR; some or all of the physis is so severely compressed that growth potential is compromised

Type VI

Rare injury to peripheral perichondrial ring which encircles the plated

Caused by direct blow or more often due to an open slicing mechanism by a sharp object

BAD prognosis

Type I, II, and III heal in about

2-3 weeks

Type IV and V heal in about

6 weeks