Pediatric physeal (growth plate) fractures

[Tariq Zaki]

Open growth plates in children are often involved in fractures. Diagnosis is by plain x-ray. Treatment is with closed reduction and immobilization or open reduction with internal fixation.
(See also Overview of Fractures.)
Bone grows as tissue is added at the physeal disk (growth plate), which is bordered by the metaphysis proximally and the epiphysis distally (see figure Salter-Harris classification of physeal disk (growth plate) fractures). The age at which the growth plate closes and bone growth stops varies by bone, but the growth plate is closed in all bones by age 20 (see figure Epiphyseal disks (growth plates)).
Before closure, the growth plate is the most fragile part of the bone and is therefore frequently disrupted when force is applied. Growth plate fractures may extend into the metaphysis and/or epiphysis; the different types are classified by the Salter-Harris system. Risk of impaired growth increases as fractures progress from type I through type V. In English, a useful mnemonic for the types is SALTR:

Salter I: S = Straight (the fracture line goes straight across the growth plate)
Salter II: A = Above (the fracture line extends above or away from the growth plate)
Salter III: L = Lower (the fracture line extends below the growth plate)
Salter IV: T = Through (the fracture line extends through the metaphysis, growth plate, and epiphysis)
Salter V: R = Rammed (the growth plate has been crushed)

Children with injuries that involve the epiphysis as well as the growth plate (Salter types III and IV) or that compress the growth plate (Salter type V) tend to have a worse prognosis.