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