An injury to the growth plate area of a child’s bone is called a Salter-Harris fracture. The growth plate of a child’s long bone is the soft area of cartilage found at the end of long bones, such as the humerus and tibia. However, Salter-Harris fractures can affect any developing long bone, from arms and legs to fingers and toes.

A child’s bone growth plate is made of cartilage that will gradually harden into solid bone when fully grown. The soft cartilage of the growth plate can be fractured by a fall or from excessive pressure. Salter-Harris fractures typically comprise 15 to 30 per cent of bone injuries in children and commonly happen during sporting activities or through falls and physical accidents.

The most common physeal injury seen is in the phalanges, which accounts for 30% of these injuries. Sporting injuries and fractures are especially common in adolescents, with injuries in boys being twice as prevalent as in girls. 

History of Salter-Harris Fractures

Salter-Harris fractures were initially defined in 1963 by Canadian doctors Robert Salter and W. Robert Harris. They classified five main types of fracture, each distinguished by how the fracture affects the growth plate and surrounding bone. The higher the classification fracture number, the higher the child’s risk of possible bone growth issues. 

Type I Salter-Harris fractures are more common in younger children and occur when a force hits the growth plate, separating the plate from the bone shaft. Type II is the most common fracture and tends to affect more children over ten.  

Paediatric fractures of the growth plate were first described by Foucher back in 1863, and Poland devised the first-ever classification system in 1898. However, the Salter-Harris classification system became the most popular descriptive anatomical classification system, which is still used today. 

Dr Salter and Dr Harris were the first to recognize that injuries occur through the zone of provisional calcification of the physis due to it being a weaker zone in transition between the calcified and non-calcified parts of the growth plate.

In our main article, you can learn more about the different types of Salter-Harris fractures and details of the recommended PDUK workshop to help advance your knowledge of X-ray interpretation and diagnosing fracture types.

Evaluation of paediatric fractures

The evaluation, treatment and management of physeal injuries in children must be accurate to help avoid growth arrest in the growth plates, which could lead to lifelong physical complications. 

It takes an interprofessional team to diagnose, treat and manage paediatric physeal injuries. Following an initial physical examination, imaging tools should be used to help evaluate injuries further. 

Physeal injuries in children can often present with vague symptoms that could indicate other possible causes:

  • Accidental trauma
  • Bone bruise
  • Infection
  • Ligamentous injuries
  • Metaphyseal/diaphyseal fracture
  • Muscle strain
  • Non-accidental trauma

Radiographs will usually reveal fractures of the physis, but ultrasound can effectively detect fractures in very young children before cartilage ossification. Physeal fractures can then be classified using Salter-Harris I-V, with each subsequent number indicating a more substantial risk of growth arrest. 

 

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