Salter-Harris Fracture Classification: The “SALTR” Mnemonic
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Example Case
A pediatric patient presents with right elbow pain after falling off a trampoline 30 minutes prior to arrival. Pain is localized to the elbow only, and the patient denies any other injuries or pain. There was no loss of consciousness.
X-ray of the right elbow shows a Salter-Harris IV fracture involving the lateral condyle of the distal humerus.
Salter-Harris Fractures
Fractures involving the physis, also known as the growth plate, can be categorized using the Salter-Harris classification system.
There are 5 different types of Salter-Harris injuries based on fracture anatomy, pattern, and prognosis: Salter-Harris I, II, III, IV, and V.
As with every EZmed lecture, you will learn a simple strategy and trick for remembering the material.
The different Salter-Harris fractures can be remembered using the fittingly appropriate mnemonic “SALTR”.
The mnemonic describes the location of injury in relation to the physis.
The SALTR Mnemonic:
S (Type I) = Straight Across the Physis
A (Type II) = Above the Physis
L (Type III) = Lower/beLow the Physis
T (Type IV) = Through the Physis
R (Type V) Ruined/cRushed Physis
Salter-Harris Type I
A Salter-Harris type I fracture can be remembered using the 1st letter of the “SALTR” mnemonic, “S”.
S = Straight Across
This will help you remember that a type I fracture travels straight across the physis.
It makes up approximately 5-7% of growth plate injuries, and cannot occur if the growth plate is already fused.
The prognosis is excellent, and treatment is usually non-operative.
A Salter-Harris type I fracture travels straight across the physis.
Salter-Harris Type II
A Salter-Harris type II fracture can be remembered using the 2nd letter of the “SALTR” mnemonic, “A”.
A = Above the physis
This will help you remember that a type II fracture involves part of the growth plate, and then travels above the physis into the metaphysis.
It is important to briefly mention the orientation of the bone when using the “SALTR” mnemonic.
In order for the mnemonic to work, the metaphysis must be oriented superior to the physis and epiphysis.
A type II fracture is the most common growth plate injury, making up approximately 75%.
The prognosis is excellent, and treatment is usually non-operative.
A Salter-Harris type II fracture travels above the physis into the metaphysis.
Salter-Harris Type III
A Salter-Harris type III fracture can be remembered using the 3rd letter of the “SALTR” mnemonic, “L”.
L = Lower or beLow the physis
This will help you remember that a type III fracture involves part of the growth plate, and then travels below the physis into the epiphysis.
They make up approximately 7-10% of growth plate injuries.
These fractures have the potential to be unstable especially if the joint space is involved.
Treatment may or may not be operative.
A Salter-Harris type III fracture below the physis into the epiphysis.
Salter-Harris Type IV
A Salter-Harris Type IV fracture can be remembered using the 4th letter of the “SALTR” mnemonic, “T”.
T = Through the physis
This will help you remember that a type IV fracture travels through the metaphysis, through the physis, and through the epiphysis.
Type IV fractures make up about 10% of growth plate injuries.
These fractures are usually unstable and they can potentially lead to limb length discrepancies.
As a result, operative management should be considered.
A Salter-Harris type IV fracture travels through the metaphysis, through the physis, and through the epiphysis.
Salter-Harris Type V
A Salter-Harris Type V fracture can be remembered using the 5th letter of the “SALTR” mnemonic, “R”.
R = Ruined or cRushed physis
This will help you remember that a type V fracture is a crush injury to the physis.
A type V fracture is the least common, comprising less than 1% of growth plate injuries.
Type V fractures can be unstable and lead to limb length discrepancies similar to type IV fractures.
As a result, operative management should be considered.
A Salter-Harris type V fracture is a crush injury to the physis.
Summary
The Salter-Harris classification system can be used to categorize fractures involving the physis, or growth plate.
There are 5 main types of Salter-Harris fractures: Type I, II, III, IV, and V.
The different fractures can be remembered using the “SALTR” mnemonic.
Type I (S) = Straight across physis
Type II (A) = Above the physis
Type III (L) = Lower or beLow the physis
Type IV (T) = Through the physis
Type V (R) = Ruined physis/crushed injury to physis
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052189/