Classification of Physeal Injury:

Salter-Harris Classification of Physeal Injury(Modification of Poland & Aitken Classification):

  1. Type I- a transphyseal plane of injury
    -no bony fracture line through the metaphysis or the epiphysis
    -usually in the zone of hypertrophy
    -growth disturbances uncommon
    -e.g.phalanges, metacarpals, distal tibia, distal ulna
    In infants-proximal humerus, distal humerus, and proximal femur
    -Xray: Normal except soft tissue swelling
    Treatment:gentle reduction of the epiphysis on the
    metaphysis with stabilization of the fragments if needed.
  2. Type II- the fracture line extends from the peripheral edge of physis
    across a variable extent of the physis, exiting into the metaphysis at the other end of the fracture.
    Thurston–Holland signEpiphyseal fragment of the fracture contains complete epiphysis & part of metaphysis.
    -limited risk of growth disturbance, but the metaphyseal “spike” of the diaphyseal/metaphyseal fragment may damage the physis.
    Treatment: gentle & adequate reduction of the fracture fragments with stabilization if needed.
  3. Type III– a fracture through the articular surface in the epiphysis extends vertically toward the physis & then courses peripherally through the physis.
    – articular surface involved,
    -involvement of germinal & proliferative layers of the physis→ higher risk of  growth disturbance
    Treatment: Anatomic reduction(usually open) restoring articular surface & stabilization/fixation in such a way to minimize the risk of growth disturbance.SH
  4. Type IV– a vertical shear fracture, from articular surface to metaphysis with articular surface disruption
    -involving all physeal layers
    -displacement of fragment→ Metaphyseal-Epiphyseal cross union                                                ↓
    Growth disturbance inevitable (without treatment)-e.g. Fracture medial malleolus; Lateral Condyle # distal humerus & Intra-articular two-part triplane # distal tibia.
    Treatment: Anatomic reduction & adequate fixation to restore articular surface & prevent metaphyseal–epiphyseal cross union.
  5. Type V– a retrograde diagnosis
    -unrecognized compression injury
    -normal initial x-ray
    -resulting into premature physeal closure.
    Treatment: of any deformity/limb shortening as needed
  6. Type VI-bruise/contusion to the periphery of the physis→ scarring/tethering/arrest of the affected peripheral part of the physis→ Angular deformity.
    Treatment: Correction of deformityOther Classification:  Peterson classification &  Aitken ClassificationPhyseal Injury Classification