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ortho-trauma paediatrics emergency

Salter-Harris Classification of Physeal Fractures

Classification of growth-plate (physis) fractures in children (Salter & Harris 1963). Higher type = greater risk of growth arrest, deformity, and need for operative fixation.

Score interpretation

Type I–II — Low risk of growth arrest 1–2

→ Closed reduction (if displaced) and immobilisation. Above-knee/elbow cast typical 4–6 weeks. Outpatient orthopaedic follow-up at 6–12 months to monitor for late growth disturbance.

Type III–IV — Intra-articular; higher growth-arrest risk 3–4

→ Anatomical reduction essential — usually open reduction internal fixation (ORIF) with smooth K-wires or screws across metaphysis (avoiding physis). 6–12 month follow-up with serial X-rays for limb-length and angular deformity.

Type V — High risk of growth arrest 5

→ Often diagnosed retrospectively. Cast immobilisation + non-weight-bearing. Long-term orthopaedic follow-up (~2 years) with growth assessment; epiphysiodesis or limb-lengthening may be required for sequelae.

Interpretation bands for the Salter-Harris. Apply clinical judgement and local guidance.

References

Related

Curated clinical cross-links plus same-class fallbacks.

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.