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 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.
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.
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 Classification