SalterHarrissystemet

Salter-Harris system is a widely used classification for fractures that involve the growth plate (physeal injuries) in skeletally immature patients. The system was introduced by Salter and Harris in 1963 and remains a foundational framework in pediatric orthopedics. It categorizes physeal injuries into five types (I–V) based on which parts of the growth plate, metaphysis, and epiphysis are disrupted, and it informs prognosis and treatment decisions.

Type I fractures pass through the physis only, with the metaphysis and epiphysis in alignment or minimally displaced. Type II fractures extend through the physis into the metaphysis, producing a small metaphyseal fragment called the Thurston-Holland fragment. Type II is the most common physeal fracture and generally carries a favorable prognosis with timely reduction and immobilization.

Type III fractures run through the physis and into the epiphysis, extending into the joint space. They are intra-articular injuries and require accurate reduction to restore articular congruity. The prognosis depends on the extent of physeal damage and the precision of alignment. Type IV fractures traverse the metaphysis, physis, and epiphysis, crossing the growth plate and often the joint surface. They have a higher risk of growth disturbance and joint incongruity, and typically require anatomic reduction and fixation to optimize outcomes.

Type V fractures are crush injuries of the growth plate, frequently with minimal initial displacement and subtle radiographic findings. They carry the highest risk of growth arrest and resultant deformity, making prognosis often guarded even with treatment.

Diagnosis is based on radiographs; MRI or CT may be used to assess articular involvement or physeal damage. Treatment ranges from immobilization after closed reduction to surgical fixation, depending on type and displacement, with careful long-term follow-up to monitor growth disturbances.