Salter-Harris (physeal) fractures - ED revision
Overview
Salter-Harris fractures injure the physis (growth plate) in children and adolescents. Early recognition, accurate imaging/reporting, appropriate analgesia and timely orthopaedic follow‑up are essential because physeal damage may cause growth arrest, limb‑length discrepancy or angular deformity.
Use the SALTR classification (Slipped, Above, Lower, Through, Rammed) to classify the five classic types. Management in the emergency department should follow national guidance for non‑complex fractures (NICE NG38) and local safeguarding procedures guided by NICE CG89 and Working Together (GOV.UK).
Pathophysiology and clinical importance
- The physis is cartilaginous and mechanically weaker than metaphyseal or epiphyseal bone, producing characteristic paediatric fracture patterns.
- Prognosis depends on involvement of the germinal/proliferative zones or the joint surface.
- Injuries extending into the epiphysis (SH III, IV) or compressing the physis (SH V) carry higher risk of growth disturbance.
- Some physeal injuries, particularly SH I and SH V, may be radiographically subtle or initially occult.
Classification (SALTR)
Clinical assessment - ED priorities
- History: mechanism (force, direction), timing, ability to weight‑bear/use the limb, prior bone disease, and estimate of skeletal maturity.
- Examination: focused inspection for swelling, deformity and wounds. Perform a full neurovascular exam distal to the injury (pulses, capillary refill, motor and sensory) before and after any manipulation - document findings precisely.