Boys complete growth at the age of 16 years. Girls complete growth at the age of 14 years. The proximal tibia contributes to approximately 6mm of growth per year. In general, the distal femur contributes to approximately 9-10mm of growth per year. Type III and Type IV do not require surgery and the prognosis is usually fair. In Type III and Type IV, the fracture is usually intraarticular and anatomic reduction is necessary. Despite this, the prognosis is usually good. In Type I and Type II, the reduction of the fracture may not be anatomic. Type I and Type II usually do not require surgery and will have a better prognosis than Type III, Type IV, and Type V. Type V has the highest incidence of growth arrest and disturbance. There is no associated fractures of the epiphysis or metaphysis. It is a compression or crush injury of the growth plate. It can cause complications such as growth disturbances and angular deformity. Type IV fracture passes through the epiphysis, the growth plate, and the metaphysis 10% of fractures are Type IV. CT scan may be needed to diagnose this fracture. An example of Type III is the Tillaux fracture of the distal tibia. It requires anatomic reduction of the joint and internal fixation. Fracture extends into the articular surface of the bone (intraarticular fracture). Type III is a fracture through the growth plate and epiphysis, sparring the metaphysis. Injury to the distal femur will cause a high rate of growth abnormality. Healing is fast and growth is usually okay. With Type II, the fragment usually stays with the epiphysis while the rest of the metaphysis will displace. The corner of the metaphysis separates (Thurston-Holland Sign). Type II is a fracture through the growth plate and the metaphysis, sparring the epiphysis. Type I is known by fast healing and rare complication rate. Fracture occurs through the weak zone of provisional calcification. Sometimes the diagnosis is a clinical one. The fracture occurs through the growth plate, and there may not be an obvious displacement. Type I Salter-Harris fracture is difficult to diagnose 5% of fractures are Type I. In fact, the hypertrophic zone is weaker than the ligaments, and it provides a cleavage zone for the fracture to occur. The majority of growth plate injuries occur in the hypertrophic zone. The hypertrophic zone of the growth plate has maturation, degeneration, and provisional calcification. The proliferating zone of the growth plate has cellular proliferation and longitudinal growth, and this zone makes a person tall or short. The reserve zone of the growth plate is the inactive zone. Growth plates produce the longitudinal growth bones. The higher of the type number, the more complications associated with the fracture and worse prognosis.

There are generally five types of Salter-Harris fractures.

It is important to diagnose these fractures as they may affect the growth of the bone if not diagnosed and treated properly. Growth plate injuries in children are common in the bones of the lower (tibia and fibula). The growth plate injuries occur more distal than proximal, such as distal radius, distal tibia, and distal phalanges. 15% of all fractures in children involves the growth plate, and it occurs more in boys than in girls. Salter-Harris fracture is a common injury in children that involves the growth plates.

Salter harris type 2