Salter-harris Fracture

What are Salter-Harris fractures?

A Salter-Harris fracture in children is when a bone breaks through a growth plate. Your child's bones grow from the growth plates near the bone ends. Salter-Harris fractures occur most often in the fingers or in the lower arm and leg.


What are the types of Salter-Harris fractures?

There are 5 types of Salter-Harris fractures:

  • Type 1: Type 1 fractures are a complete break through the growth plate.

  • Type 2: Type 2 fractures break through the growth plate and crack through part of the bone shaft (long part of the bone).

  • Type 3: Type 3 fractures go through part of the growth plate and crack through part of the bone end.

  • Type 4: Type 4 fractures go through part of the bone shaft, growth plate, and bone end.

  • Type 5: Type 5 fractures occur when the growth plate is crushed.

What increases the risk of Salter-Harris fractures?

  • Growth: Any child who is still growing is at risk for Salter-Harris fractures. Teenage boys have the highest risk.

  • Sports: Salter-Harris fractures are common among gymnasts, basketball players, and football players. The fracture can also develop over time with hard sports training.

  • Falls: Falls from bikes, skateboards, or skis can lead to Salter-Harris fractures.

  • Motor vehicle accidents: The force from a car, motorcycle, or all-terrain vehicle (ATV) accident can cause a Salter-Harris fracture.

  • Assault or abuse: Hard pulls or twists to the arm or leg can break the growth plate.

What are the signs and symptoms of Salter-Harris fractures?

  • Pain and swelling

  • Tenderness

  • Change in shape of the injured area that is different than normal

  • Not able to move or put weight on the injured arm or leg

How are Salter-Harris fractures diagnosed?

Your child's caregiver will ask when symptoms began. If your child is hurt, he will ask how the injury happened. He will gently press on the area to check for swelling and tenderness. He will ask your child to show where it hurts and to move the injured area if he can. Your child may need any of the following:

  • X-rays: X-rays are pictures of your child's bones to check for fractures. Several pictures may be taken.

  • CT scan: This test is also called a CAT scan. This is a type of x-ray that uses a computer to take pictures of your child's arm or leg. Your child may be given a dye, also called contrast, before the pictures are taken to help caregivers see the pictures better. People who are allergic to iodine or shellfish may be allergic to some dyes. Tell your child's caregiver if your child is allergic to shellfish or has other allergies or medical conditions.

  • MRI: Magnetic waves are used to take pictures of your child's arm or leg. Your child will need to lie still during an MRI. Never enter an MRI room with any metal objects. This can cause serious injury.

How are Salter-Harris fractures treated?

Treatment depends on the type of fracture your child has and how severe it is. Your child may need any of the following:

  • Pain medicine: Your child may be given medicine to take away or decrease pain.

  • Cast or splint: A splint stops movement in the injured area until more treatment is done. If the bone is not displaced (moved out of place), your child may get a cast to secure the bone as it heals. Casts are also used after reduction (when the bone is put back into place) or surgery.

  • Surgery: Your child may need surgery to repair certain types of Salter-Harris fractures. Pins or screws will be placed inside the broken bone. These hold the bone pieces together in the correct places.

What are the risks of Salter-Harris fractures?

You child's bone may not heal or heal poorly. Over time, bone growth can slow or stop with some types of Salter-Harris fractures. The limb may become bent or shortened with a limited range of motion (movement). Your child could develop an infection from his injury. Salter-Harris fractures can also damage the nerves, blood vessels, and muscles around the bone.

What can I do to help my child's Salter-Harris fracture heal?

Your child may need the following:

  • Elevate: Keep the cast or splint above the level of your child's heart, as often as possible, for 1 to 3 days. Your child may lie back in a bed or chair and put pillows under an injured leg or foot. Use pillows to prop up an injured arm or hand. Your child should wiggle his healthy fingers and toes often.

  • Ice: Use ice to help decrease pain and swelling. Put crushed ice in a plastic bag and cover it with a towel. Place the ice over the cast or splint for as long and as often as your child's caregiver says you should.

  • Splint or cast care: Use plastic or waterproof shields to keep the splint or cast dry when your child bathes. Keep powder, dirt, and sand out of the cast or splint. Do not pull out the padding or break off hard edges of the cast. Your child should not scratch the skin under the cast with coat hangers or other sharp objects.

How can sports injuries be prevented?

  • Regular checkups: Your child should see a caregiver for sports exams as suggested. Ask your child to tell you when he is hurt. Regular checkups may catch unknown injuries before they get worse.

  • Exercise changes: Your child should not do the same exercises or drills every day.

  • Safe play: Make sure your child competes with other children of the same size, fitness level, and skill.

  • Rest: Rest periods are needed during sports training. If your child is injured, he may need to avoid contact sports for 4 to 6 months to prevent another injury.

When should I follow up with my child's caregiver?

Your child's caregiver may need to check the fracture each week as it heals. Ask your child's caregiver how often your child should return for visits. Ask if your child should see a specialist.

When should I contact my child's caregiver?

Contact your child's caregiver if:

  • You have a fever.

  • You see swelling below the splint or cast.

  • Your child's cast is cracked or has soft spots.

  • You have questions about your child's condition or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • Your child's pain gets worse, even with medicine.

  • Your child says his cast or splint feels too tight.

  • The skin under your child's cast or splint is tingling or numb.

  • Your child can no longer move his fingers or toes.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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