Salter Harris



Buckle or Torus fracture

- metaphyseal-diaphyseal junction

- compression fracture

- compression side has undergone plastic deformation


Greenstick Fracture

- diaphyseal injury

- failure tension side

- plastic deformity compression side


Greenstick Fracture APGreenstick Fracture Lateral


Plastic Deformity

- microscopic failure

- forearm and fibula




Primary ossification centres

- diaphyseal


Secondary ossification centres

- epiphyseal


Physeal Anatomy


Reserve Zone

- few cells, high matrix

- cells from Groove of Ranvier

- cells quiescent


Proliferative Zone

- cellular proliferation / mitosis

- columns of cells

- longitudinal growth

- metaphyseal side


Hypertrophic zone


A.  Maturation

- enlarged, swollen, vacuolated


B.  Degeneration

- increase Alk Phos

- increases phosphate for calcification


C. Provisional calcification

- ECM calcify

- cell death


Perichondral Ring of La Croix & Groove of Ranvier


Surround the physis circumferentially at its periphery


Groove - resting and proliferating cells


Ring - cartilage cells that move towards the metaphysis and become contigous with periosteum


Salter Harris Classification


Salter Harris Classification


I.  Whole epiphysis is separated from shaft


II. Fracture through metaphysis and physis


III. Separation of part of the  epiphysis

- fracture through physis and epiphysis


IV. Fracture passes vertically through epiphysis / physis / metaphysis


Salter Harris IV Toe


V. Crushing of part or all of the epiphysis


Physeal fractures


Thought to occur primarily through hypertrophic zone


Reserve zone injury

- increased growth arrest with proximal tibia and distal femur

- because of undulating course of physis

- more likely damage to germinal or resting layers




Do not remanipulate physeal injuries > 7-10 days

- risk injury

- exception type 3/4 

- in these anatomical reduction more important


Metaphyseal / diaphyseal

- can MUA up to 3 weeks after