Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system.

Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate.

Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures.

Type III fractures occur through the growth plate and epiphysis. Type III injuries are intra-articular, and the diagnosis is made radiographically based on the appearance of an epiphyseal fragment not associated with a metaphyseal fracture.

Type IV fractures are also intra-articular and occur through the growth plate, metaphysis and epiphysis.

Type V fractures occur when there is a crush injury of the growth plate. The prognosis is poor because growth arrest and partial physeal closure are common.

Jorge Muniz is an internal medicine physician assistant, illustrator, and author of Medcomic: The Most Entertaining Way to Study Medicine.

Image credit: Medcomic.com