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Write a short note on Salter–Harris Physeal Injuries.

General Surgery · Final Professional

Definition

The Salter–Harris classification describes fractures involving the growth plate (physis) in children. It is important because physeal injuries can disturb growth, and the type predicts both the risk of growth arrest and the treatment.

Salter–Harris types I–V (red = fracture line/injury). The mnemonic ‘SALTR’ aids recall.

Type	Mnemonic (SALTR)	Line
I	S – Slip(ped)	Through the physis only
II	A – Above	Physis + metaphysis (commonest)
III	L – Lower	Physis + epiphysis (intra-articular)
IV	T – Through	Metaphysis + physis + epiphysis
V	R – Ram(med)/cRush	Crush injury of the physis

CLINICAL PEARL

Use ‘SALTR’: I Slipped, II Above, III Lower, IV Through, V cRush. Type II is the commonest; types III–V (especially V) carry the highest risk of growth arrest and joint problems.

Management & Prognosis

Type I and II injuries are usually treated by closed reduction and immobilisation and generally have a good prognosis. Type III and IV are intra-articular and often need anatomical (open) reduction and fixation to restore the joint surface and physis. Type V is frequently diagnosed retrospectively and has the worst prognosis for growth disturbance. All physeal injuries warrant follow-up for growth arrest (angular deformity or limb-length discrepancy from a physeal bar).

KEY POINT

Key points TO remember

Classifies growth-plate fractures; predicts growth-arrest risk and treatment.
SALTR: I Slipped, II Above (commonest), III Lower, IV Through, V cRush.
I–II → closed reduction; III–IV (intra-articular) → anatomical/open fixation.
Type V worst prognosis; follow up all physeal injuries for growth arrest.

EXAM TIP

Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.

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