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Salter-Harris Classification System

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Let's spend a few minutes

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and talk about physeal injury.

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And this is, of course, the Salter

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Harris Classification System.

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One thing to remember about this

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classification system is that it can only

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be applied if your physis is still open.

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Once your physis has closed,

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this system cannot be applied.

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Because it's a system that talks

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about prognosis, it has implications

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for growth, it has implications

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for varus and valgus abnormalities.

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So, once the physis is closed,

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those things are less relevant.

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How do we know a physis is open?

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Well, you look at the skeletal system and

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you see little bands of lucency. That's

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how you know the physis is still open.

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When the physis does close, it'll

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have what's called a physeal scar.

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So the band of tissue between the

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epiphysis will sort of be white.

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And over time, this will disappear

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and it'll look like a single bone.

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So, the Salter Harris system can only

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be applied again if your physis is open.

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Here we have a characteristic

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image that demonstrates a physis.

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So, we're looking at the physis.

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So, we're, of course, talking about this.

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That is your physis.

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Any Salter Harris injury has to

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involve the physis to some degree.

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I'll write that.

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So, a Salter Harris I injury, which is

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sometimes very difficult to tell because

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you're looking for widening of that physis.

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It has to go directly

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through the physis like this.

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As you can imagine, if there's already a lucency

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there on radiograph, seeing a slight widening

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of that lucency can be a little problematic.

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That's why you have the contralateral side

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and other adjacent physes to help you.

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For example, the fibular physis.

1:59

Sometimes if you have a fracture to the

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physis of the distal tibia, you can compare

2:02

it to the width of the physis of the

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fibula, and then you can determine whether

2:07

you think there is a fracture or not.

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So, that's a Salter I injury.

2:11

Salter II injury, again, has to

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involve the physis, and it goes

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through the metaphysis that way.

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Okay?

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That's Salter II.

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And it goes through the

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metaphysis in any direction.

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Salter III goes through the

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physis and exits the metaphysis.

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out the epiphysis.

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Salter IV goes through the physis and involves

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both the metaphysis and the epiphysis.

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And finally, a Salter Harris V, which is

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also a little difficult, involves just

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the physis, but the physis is crushed.

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So that lucency or that gap that you see

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is actually narrower than it should be.

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So that's a Salter Harris V injury, okay?

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And why do we do that?

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Why do we classify?

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Because Salter Harris injury

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has a prognostic factor.

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It lets us know what the likelihood of physeal

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bar formation, leg length discrepancy, things

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like that are, what are the possibilities.

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The higher the Salter Harris

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number, the worse the prognosis.

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But it's not just the Salter Harris that we

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have to worry about as far as physeal injury.

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The particular physis actually

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has a lot to do with it.

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For example, the majority of physeal

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injuries happen around the fingers, like

3:40

the DIP, PIP, around that area.

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Yet, the majority of physeal-related

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complications happen around the knees.

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So it's, no matter what the

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classification of the Salter Harris.

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If the Salter Harris is four or five,

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if it's in the fingers, you end up

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not having as many complications as

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even a two or three around the knees.

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So Salter Harris is one thing to think about.

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Also, which particular physes

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are involved is another thing to think

4:11

about when we look at complications.62 00:02:30,315 --> 00:02:31,295 out the epiphysis.

2:32

Salter IV goes through the physis and involves

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both the metaphysis and the epiphysis.

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And finally, a Salter Harris V, which is

2:46

also a little difficult, involves just

2:49

the physis, but the physis is crushed.

2:54

So that lucency or that gap that you see

2:58

is actually narrower than it should be.

3:00

So that's a Salter Harris V injury, okay?

3:04

And why do we do that?

3:05

Why do we classify?

3:07

Because Salter Harris injury

3:08

has a prognostic factor.

3:11

It lets us know what the likelihood of physeal

3:14

bar formation, leg length discrepancy, things

3:18

like that are, what are the possibilities.

3:21

The higher the Salter Harris

3:22

number, the worse the prognosis.

3:25

But it's not just the Salter Harris that we

3:28

have to worry about as far as physeal injury.

3:30

The particular physis actually

3:32

has a lot to do with it.

3:34

For example, the majority of physeal

3:38

injuries happen around the fingers, like

3:40

the DIP, PIP, around that area.

3:44

Yet, the majority of physeal-related

3:47

complications happen around the knees.

3:51

So it's, no matter what the

3:53

classification of the Salter Harris.

3:55

If the Salter Harris is four or five,

3:58

if it's in the fingers, you end up

4:00

not having as many complications as

4:02

even a two or three around the knees.

4:04

So Salter Harris is one thing to think about.

4:06

Also, which particular physes

4:09

are involved is another thing to think

4:11

about when we look at complications.

Report

Faculty

Mahesh Thapa, MD, MEd, FAAP

Division Chief of Musculoskeletal Imaging, and Director of Diagnostic Imaging Professor

Seattle Children's & University of Washington

Tags

X-Ray (Plain Films)

Trauma

Pediatrics

Musculoskeletal (MSK)

MRI

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