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Review
. 2016 Nov;474(11):2531-2537.
doi: 10.1007/s11999-016-4891-3. Epub 2016 May 20.

Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures

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Free PMC article
Review

Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures

Daniel J Cepela et al. Clin Orthop Relat Res. .
Free PMC article

Figures

Fig. 1
Fig. 1
The histology of the physis with standard hematoxylin and eosin staining is shown. The top of the slide is oriented toward the epiphysis while the bottom is oriented toward the metaphysis. The four zones of the physis and the surrounding fibrocartilaginous structures are shown. The most common region for physeal fractures to occur is through the zone of provisional calcification, which is a subzone of the zone of hypertrophy.
Fig. 2
Fig. 2
The five basic fracture types of the Salter-Harris classification are shown. A Type I fracture is a separation through the physis. A Type II fracture enters in the plane of the physis and exits through the metaphysis. The resulting metaphyseal fragment is called the Thurston-Holland fragment (*). A Type III fracture enters in the plane of the physis and exits through the epiphysis. A Type IV fracture crosses the physis, extending from the metaphysis to the epiphysis. A Type V fracture is a crush injury resulting in injury to the physis.
Fig. 3
Fig. 3
This radiograph shows a Salter-Harris Type I fracture of the distal tibia. The fracture is in the plane of the physis (white arrows).
Fig. 4
Fig. 4
A Salter-Harris Type II fracture of the distal tibia is shown. The path of the fracture is from the lateral metaphysis to the medial physis (white arrows). The resulting metaphyseal Thurston-Holland fragment is denoted by the asterisk.
Fig. 5
Fig. 5
This radiograph shows a Salter-Harris Type III facture of the distal tibia. The fracture is intraarticular, exiting through the epiphysis (white arrows).
Fig. 6
Fig. 6
The injury at the distal tibial sustained by a pediatric patient is a Salter-Harris Type IV fracture (white arrows) and can be seen traveling from the medial metaphysis to exit through the epiphysis. The injury at the distal fibula is a Salter-Harris Type I fracture (white line).
Fig. 7
Fig. 7
This radiograph shows a Salter-Harris Type V fracture or crush injury to the physis of the proximal radius. The smaller arrows show the path of the fracture while the larger arrows represent the compressive force causing the injury.
Fig. 8
Fig. 8
The Peterson classification adds two new fracture variants to the Salter-Harris classification. A Peterson Type I fracture is transmetaphyseal with extension into the physis, and a Peterson Type VI fracture has loss of part of the physis and typically is described as an open “lawnmower” type of injury.
Fig. 9
Fig. 9
This radiograph shows a Peterson Type I fracture of the distal radius. The fracture line is marked by arrows and can be seen crossing the metaphysis, and also extending into the physis.

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