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Pediatrics Case 3 Background

Salter-Harris Type IV Fracture of the proximal middle phalanx

Red=Metaphyseal fracture; Blue=Epiphyseal fracture

Children commonly sustain injuries of the physis because the cartilaginous growth zone that bridges the physis is weaker than bones and ligaments. Salter-Harris classification is used to describe five patterns of physeal injuries. A Salter Harris Type IV fracture is through the metaphysis, growth plate (physis), and epiphysis.  These are intraarticular fractures

The most feared complication of physeal fractures is premature growth cessation, resulting in shortening of the affected bone. This is most likely to occur with Salter-Harris types III, IV, and V fractures. Because the germinal layer of the growth plate is not involved in types I and II, growth disturbances are less likely to occur with these fractures.

The relative prevalence of the various Salter-Harris fracture types is as follows: type I, 6% of all physeal fractures; type II, 75%; type III, 8%; type IV, 10%; type V, 1%.