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injuries generally occur through the zone of provisional calcification, a relatively
weak area of the germinal growth plate that becomes even more susceptible to
injury during periods of growth in adolescence (peak incidence at 11 to 12 years
old). Most growth plate injuries occur in the upper limb, particularly in the radius
and ulna.
Several classification systems have been described for physeal fractures. The
most widely used is that of Salter and Harris, who described five types of growth
plate fractures, each having specific prognostic and treatment implications ( Fig.
111.2 ).
Salter –Harris type I fracture. This fracture type is a separation of the
metaphysis from the epiphysis through the zone of provisional calcification
resulting in a widening of the physeal space. Diagnosis may be challenging if
displacement is minimal. Radiographs may only show associated soft tissue
swelling. Type I fractures are generally benign, and growth disturbance is
uncommon if near-anatomic reduction is achieved. Exceptions include type I
injuries of the proximal and distal femur and the proximal tibia, which are subject
to premature physeal closure and posttraumatic growth arrest. In general, when
radiographic studies are negative, but physical examination findings are
suggestive of a Salter–Harris type I injury (e.g., point tenderness over a growth
plate), immobilization and a follow-up examination are essential. Imaging
showing periosteal reaction along the physis 7 to 10 days after possible Salter–
Harris fractures may help diagnose the occult injury.