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FIGURE 111.2 The Salter–Harris classification for physeal fractures. The prognosis for growth
disturbance worsens from type I through type V.

Salter –Harris type II fracture. Type II fractures are the most common type of
pediatric physeal fracture. These fractures extend through both the physis and the
metaphysis. Like the type I injuries, these fractures generally carry a good
prognosis and rarely cause functional deformity.
Salter –Harris type III and IV fractures. Type III and IV injuries are growth
plate injuries that involve the intra-articular surface. In type III fractures, the
fracture line typically extends from the epiphysis into the physis, resulting in a
separation of the epiphysis and its associated growth plate from the rest of the
epiphysis. The fracture line in type IV injuries crosses through all three regions of
the bone (epiphysis, physis, and metaphysis). Anatomic position must be
reestablished to restore normal joint mechanics and prevent growth disturbance.
Because of these risks, which may result in functional disability, orthopedic
consultation should be obtained while the patient is in the ED for all but the most
minor type III and IV injuries.
Salter –Harris type V fracture. Type V fractures are the least common physeal
fracture, and most commonly occur at the knee and ankle. These fractures are a
crushing injury of the growth plate as a result of axial compression. It is often
difficult to diagnose these injuries during the ED presentation, but a high index of