Tiny Tips: SALTR for Pediatric Growth-plate Fractures

Up to one half of all children’s visits to the ED are orthopedic in nature [1]. Of these visits, approximately 35% are fractures that involve the growth plate, or physis, of a developing bone [2]. ED physicians must be familiar with the Salter-Harris classification system, which is the most commonly used system [3] for describing growth plate fractures.

An easy mnemonic to remember the fracture type and description is SALTR:

Type I	Straight across	Fracture in directly through the physics, separating end from shaft
Type II	Above	Fracture extends through metaphysis into physis. Most common fracture type, accounting for 75%of all growth plate fractures.
Type III	Lower	Extends through physis into epiphysis, or lower aspect of the bone.
Type IIII	Through	Extends across metaphysis, physis, and epiphysis.
Type V	Rammed	Crush injury to physis. Rarest type of growth plate fracture.

References

Thornton M, Della-Giustina K, Aronson P. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am. 2015;33(2):423-449. PMID: 25892730
Rezaee A, Gaillard F. Salter Harris Fractures. Radiopaedia. http://radiopaedia.org/articles/salter-harris-fractures. Published 2016. Accessed May 15, 2016.
Wuerz T, Gurd D. Pediatric physeal ankle fracture. J Am Acad Orthop Surg. 2013;21(4):234-244. PMID: 23545729

Reviewing with the Staff

Fractures involving the growth plates certainly are common injuries that we see in the ED. I am definitely a fan of mnemonics and SALTR is one of the ones that I use. When I’m teaching it, however, I always have to be careful to make sure “Above” and “Below\" aren’t seen as synonymous with “Proximal” and “Distal”, respectively. Salter Harris II of the distal radius will extend through the growth plate and then proximally into the physis, versus while Salter Harris II of the proximal phalanx will extend through the growth plate and then distally into the physis. When this is understood, this is a great mnemonic!

Kaif Pardhan

Kaif Pardhan is a medical education and politics geek who practices emergency medicine in Toronto, Ontario and pediatric emergency medicine in Hamilton, Ontario.

@kaifpardhan