Reference — Pediatrics
Salter-Harris Fracture Reference
The growth plate is the weakest part of a child’s bone, so children fracture there instead of spraining. Salter-Harris grades how the fracture line crosses the plate — and the grade predicts the one thing unique to pediatric fractures: the risk to future growth.
Educational use only. Classification and reduction decisions are made by the provider from imaging; nursing care focuses on neurovascular assessment, immobilization care, and follow-up. Growth-arrest surveillance is part of long-term orthopedic follow-up. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Why the Growth Plate Matters
The physis (growth plate) is cartilage and is weaker than the surrounding bone, ligaments, and tendons — so the same force that sprains an adult’s ankle fractures a child’s growth plate. Damage to the physis can cause growth arrest, limb-length discrepancy, or angular deformity years later, which is why a seemingly minor pediatric injury gets imaged, classified, and followed.
The Five Types — SALTR
| Type | SALTR | Fracture pattern | Outlook |
|---|---|---|---|
| Type I | S — Slipped | Fracture THROUGH the physis (growth plate) only; epiphysis 'slips.' Often normal X-ray — tenderness over the plate is the clue | Usually good |
| Type II | A — Above | Through the physis and up through the metaphysis (above the plate). The MOST COMMON type | Usually good |
| Type III | L — Lower | Through the physis and down through the epiphysis (lower); intra-articular | Guarded — joint involved |
| Type IV | T — Through (Two/Together) | Through metaphysis, physis, AND epiphysis — crosses the whole plate | Higher growth-arrest risk |
| Type V | R — Rammed (cRush) | Crush/compression injury to the physis; often subtle initially | Worst — high growth-arrest risk |
Higher type number generally means greater growth-plate involvement and higher growth-arrest risk (with Type V often the worst despite a subtle initial X-ray).
Presentation & Nursing Care
Presentation: point tenderness directly over the growth plate, pain, swelling, refusal to bear weight or use the limb after a fall/twist. A Type I can have a normal X-ray — tenderness over the physis is treated as a fracture until proven otherwise.
Care: neurovascular checks (the 5 P’s), immobilization (cast/splint) care and elevation, pain control, and teaching cast precautions. Emphasize follow-up — growth-plate injuries need monitoring over time, and parents must keep orthopedic appointments even after the limb “feels fine.”
NCLEX Pearls
- ✦Children fracture the growth plate where adults sprain — the physis is the weakest link.
- ✦SALTR: I Slipped (through plate), II Above (most common), III Lower, IV Through all, V Rammed/crush (worst).
- ✦Type II is the most common; Types IV–V carry the highest growth-arrest risk.
- ✦Point tenderness over the growth plate = treat as a fracture even if the X-ray looks normal (Type I).
- ✦Stress follow-up — growth disturbance can appear months to years later.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →