Salter-Harris Fracture

  • Etiology: trauma
  • Imaging: fracture appearance acronym in relation to growth plate is SALTR – I = Slipped, II = Above (into metaphysis), III = BeLow (into epiphysis), IV = Through, V = Rammed
    — Type I is fracture through physis
    — Type II is fracture through physis and metaphysis
    — Type III is fracture through physis and epiphysis
    — Type IV is fracture through epiphysis to metaphysis
    — Type V is crush injury to physis
  • Complications: in Types III / IV / V can see bony bridge forming across growth plate during healing leading to premature fusion of growth plate and length discrepancy

Cases of Salter-Harris Type I Fracture

Radiograph of Salter-Harris Type I fracture of the distal fibula
AP radiograph of the ankle shows a tremendous amount of swelling of the lateral malleolus with the apex of the swelling centered on the distal fibular physis. There is a small bony fragment near the physis as well thought to be from an avulsion injury.
Radiograph and CT of slipped capital femoral epiphysis
AP radiograph of the pelvis (upper left) shows the left femoral metaphysis to be displaced laterally from its epiphysis. This is better demonstrated on the coronal CT without contrast of the pelvis (upper right) and 3D CT of the pelvis (below)

Cases of Salter-Harris Type II Fracture

Radiograph of Salter-Harris Type II fracture of the radius
Lateral radiograph of the wrist shows a fracture through the radial physis and extending up into the radial metaphysis.
Radiograph of Salter-Harris Type II fracture of the distal phalanx
AP (left) and lateral (right) radiographs of the first toe show soft tissue swelling around the toe and a small bone fragment in the center of the distal physis anteriorly.

Cases of Salter-Harris Type III Fracture

Radiograph and CT of Tillaux fracture
AP (upper left), mortise (upper right) and lateral (lower left) radiographs of the ankle show a lucency through the lateral aspect of the tibial epiphysis that is better demonstrated on the sagittal CT 2D reconstruction without contrast of the ankle (lower right)
Radiograph and CT of triplane fracture
AP (left upper) and lateral (right upper) radiographs of the ankle show a sagittal fracture through the tibial epiphysis, an axial fracture through the physis, and a coronal fracture through the tibial metaphysis. This is better demonstrated on the coronal (lower left) and sagittal (lower right) CT 2D reconstructions without contrast of the ankle.

Cases of Salter-Harris Type IV Fracture

Radiograph of Salter-Harris Type IV fracture of the proximal aspect of the middle phalanx
AP radiograph of the hand shows a linear lucency in the fourth middle phalanx extending from the metaphysis through the physis and into the epiphysis. There is associated cortical irregularity along the medial aspect of the metaphsis.

Cases of Salter-Harris Type V Fracture