In Salter Harris fracture type 1 the fracture line extends “through the physis” or within the growth plate.
The physis closes in children at varying ages.
The physis or growth plate is a weak part of cartilage present in the developing bone. They may even cross several zones depending on the type of injury or the external force that is applied (e.g., shear vs. Physeal fractures tend to occur through the zone of provisional calcification. In the event of a fracture, the blood supply which enters the bone through the epiphysis may become compromised. The zone of hypertrophic/maturing cells is involved when fractures occur. In the physis, four zones are described from the epiphysis toward the metaphysis: (1) resting cells, (2) proliferating cells, (3) hypertrophic/maturing cells, and (4) provisional calcification. When a child is fully grown, the growth plates harden into solid bone. Instead, growth occurs at each end of the bone around the growth plate. The long bones of the body do not grow from the center outward. Growth plates are located between the widened part of the shaft of the bone (the metaphysis) and the end of the bone (the epiphysis). Examples of long bones include the femur (thighbone), the radius and ulna in the forearm, as well as the metacarpal bones in the hands. Once a child or adolescent completes his or her growth spurt, the plate will eventually ossify and form an epiphyseal line. Most long bones in the body contain at least two growth plates (one at each end), a hyaline cartilage plate located between the epiphysis and metaphysis near both ends of a long bone. They are thereby able to sustain greater external loads to the joint, relative to the growth plate itself 4). Active children are the most likely to encounter injuries involving the growth plate as the ligaments and joint capsules surrounding the growth plate tend to be much stronger and more stable. Most of these Salter-Harris fractures occur during the time of a child’s growth spurt when their bone’s growth plates are the weakest. Girls are affected at a younger age (11 to 12 years) than boys (12 to 14 years). Males are more likely to be affected because they have an increased tendency to engage in high-risk activities.
Of the five most common Salter-Harris fracture types, type II is the most common (75%) followed by types III (10%), IV (10%), type I (5%), and lastly, type V which is very rare 3). In general, upper extremity injuries are more common than lower-extremity injuries. Harris-Salter fractures are described exclusively in children and do not occur in the well-developed bones of adults. Salter-Harris fractures are common among children and comprise 15% to 30% of all bony injuries. Salter-Harris fracture classification system used to grade fractures according to the involvement of the growth plate (physis), metaphysis, and epiphysis is important as it has implications for both prognosis and treatment 2). Salter-Harris fracture also called growth plate fracture or physeal fracture, refers to fractures through a growth plate (physis) and are therefore specifically applied to bone fractures in children 1). Salter Harris fracture long-term outcomes.
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