Salter-Harris Fracture (Growth Plate Fracture)

A Salter-Harris fracture is a type of broken bone in a child’s growth plate. That’s why it’s also known as a growth plate fracture.

The growth plate is a section of cartilage that kids and teens have at both ends of some bones, including the:

• Upper arm bone
• Forearm bones, the radius and ulna
• Bones in the palm of your hand
• Thigh bone

The growth plate is exactly what it sounds like. It’s a special piece that helps bones grow and develop into the correct size and shape. Growth plates harden into solid bone when a child has finished growing.

Visit a healthcare provider if your child has bone pain, swelling, or one of their body parts looks noticeably different or out of place. Most Salter-Harris fractures take several weeks to heal. It’s important to get them diagnosed and treated right away.

Types of Salter-Harris fractures

Salter-Harris fractures get their name from the classification system healthcare providers use to divide them into five types:

• Salter-Harris type 1 (slipped) fractures: A break separates the growth plate cartilage from the end of your child’s bone.
• Salter-Harris type 2 (above) fractures: The crack in your child’s growth plate spreads to the shaft of their bone. These are the most common type.
• Salter-Harris type 3 (lower) fractures: The fracture breaks a piece of growth plate and the end of the affected bone loose. Type 3 growth plate fractures are more common in teens and older children because their growth plates have started hardening into adult bone.
• Salter-Harris type 4 (through or transverse) fractures: These are similar to type 3 fractures, but more severe. The fracture breaks off a piece of growth plate, the end of the bone and its shaft.
• Salter-Harris type 5 (rammed or ruined) fractures: This is a crack in the growth plate from crushing pressure on a bone. These are rare.

Symptoms of a growth plate fracture

The most common Salter-Harris fracture symptoms include:

• Bone pain
• Your child’s body part looking noticeably different (bent, crooked or out of place)
• Inability to move or use a body part
• Swelling
• Discoloration or bruising
• Tenderness

Younger children might not be able to tell you they’re injured or describe what they’re feeling. Look for your child suddenly favoring a part of their body. They might reflexively hold their injured limb close to their body, wince or limp.

Salter-Harris fracture causes

Sudden traumas are the most common causes of growth plate fractures, including:

• Falls
• Sports injuries
• Car accidents

Overtraining or specializing too soon in one sport can put repetitive stress on your child’s growth plates. This can lead to a fracture. Children and teens shouldn’t play the same sport year-round until their bodies finish developing.

Growth plate risk factors

Any child can experience a growth plate fracture. But some are more likely than others, including:

• Teens: Most Salther-Harris fractures affect teenagers.
• Males: Males are twice as likely to experience a growth plate fracture. That’s because females usually develop and mature faster. Their bones harden into adult bones sooner.
• Athletes: Kids who play sports with lots of jumping — like basketball, gymnastics, skiing or volleyball — have a higher risk. Salter-Harris fractures can also happen outside of organized sports, during physical activities like skateboarding, sledding or biking.

Salter-Harris fracture complications

Most growth plate fractures don’t lead to complications. That’s especially true if a healthcare provider diagnoses and treats them within a week of the original injury. Rare complications can include:

• Malunion: This happens when a broken bone doesn’t line up correctly while it heals.
• Nonunion: The bone may not grow back together fully or at all.
• Stunted growth: It’s rare, but severe Salter-Harris fractures (especially type 5) can affect how that bone grows in the future. It might be shorter or smaller than usual. Your child might need surgery to prevent this.

How doctors diagnose growth plate fractures

A healthcare provider will diagnose a Salter-Harris fracture with a physical exam and imaging tests. Your provider will examine the area around the injury. They might check whether your child can move part of their body. They’ll compare it to the other, uninjured limb.

Tell your provider anything you know about what your child was doing before the injury. This includes when you first noticed something was wrong or when they felt pain.

Your provider will use at least one type of imaging test to take pictures of your child’s bones and the other tissue around their injury. They might need:

• X-ray
• MRI
• CT scan

Salter-Harris fracture treatments

Wearing a cast is the most common Salter-Harris fracture treatment. The cast will protect your child’s bone and hold it in the correct position while it heals. Your provider will tell you the type of cast your child will need. They’ll also tell you how you can help your child take care of it.

Growth plate fracture surgery

It’s rare to need surgery to repair a growth plate fracture. It’s more common with more severe fractures (types 3, 4 or 5).

If your child needs surgery, a surgeon will perform what’s called an internal fixation. They’ll realign your child’s bone. Then, they’ll put fasteners — like metal screws, pins or wires — in the bone to hold it in place while it heals.

Your child might need follow-up surgery to remove the fasteners after their bone heals. Your provider or surgeon will tell you what to expect.

Growth plate fracture healing time

Most kids need to wear a cast for around a month after a growth plate fracture (usually four to six weeks). It might take longer if they had a more severe type of fracture, or if they needed surgery.

Your provider will tell you what to expect. The healing time depends on which of your child’s bones was injured and the type.

When should I see my healthcare provider?

Visit a healthcare provider right away if your child experiences trauma, like a severe fall or car accident.

Go to the emergency room if you think your child has a broken bone. And go to the ER if they’re experiencing any of the following symptoms:

• Severe pain
• Inability to move a body part
• A noticeably different-looking or out-of-place body part
• Visible bone through the skin
• Severe swelling
• New bruising or discoloration that happens at the same time as any of these other symptoms

What can I expect if my child has a growth plate fracture?

Most Salter-Harris fractures heal without long-term effects on a child’s health and development. Getting a growth plate fracture diagnosed as soon as possible is the best way to reduce their risk of complications.

Ask your provider when it’s safe for your child to return to sports or resume physical activities. If your child’s growth plate hasn’t completely healed before they start putting stress on it again, there’s an increased risk of complications (including refracturing it).