Skip to main content

Health condition · Clinically reviewed

Growth plate fractures, Salter-Harris types, careful reduction and lifelong growth in mind.

Physeal fractures are common in children and adolescents. Early recognition, accurate classification and specialist paediatric orthopaedic follow-up protect future growth.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered paediatric orthopaedic clinician before publication.

  • 02

    Sourced from guidance

    Cross-checked against BSCOS, BOAST and peer-reviewed paediatric orthopaedic sources listed at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including the Salter-Harris classification, safeguarding, and growth arrest surveillance.

Key facts

Growth plate fractures at a glance.

The essentials for parents and older children, in plain English - what a physeal fracture is, how it is classified and what treatment looks like.

  • What it is

    A fracture involving the physis, the cartilaginous growth plate at the end of a long bone in a growing child or adolescent.

  • How common

    Very common - physeal injuries make up around 30 per cent of paediatric long bone fractures.

  • Classification

    Salter-Harris types I to V - the higher the number, generally the higher the risk of growth disturbance.

  • Most common type

    Type II - through the physis and metaphysis, with a Thurston-Holland fragment - accounts for around 75 per cent.

  • Common sites

    Distal radius (most common), distal tibia, phalanges, distal humerus and distal femur.

  • Key risk

    Growth arrest, angular deformity and limb length discrepancy - hence the need for specialist paediatric orthopaedic care and follow-up.

Why this guide matters

A growing bone deserves careful hands.

Growth plate fractures are common, but subtle. Three principles shape everything that follows - classification, protecting the physis and safeguarding.

  • Classify accurately, from the first X-ray

    Salter-Harris types I to V guide treatment and prognosis. Getting the classification right at the outset matters.

  • Protect the physis at every step

    Reduction, fixation and follow-up are all designed to protect the growth plate and preserve future growth.

  • Safeguarding is part of the assessment

    For every child - especially the very young - the story and pattern of injury are reviewed with safeguarding in mind.

How the diagnosis is made

From the injury to a specialist plan.

The steps a UK emergency department and paediatric orthopaedic team will normally follow - so you know what to expect and why.

  1. 01

    Assessing

    History and mechanism

    A careful account of the injury, sport, fall or trauma - and a safeguarding review when the history is inconsistent or the child is very young.

  2. 02

    Assessing

    Focused examination

    Inspection, palpation, gentle range of movement, and a full neurovascular and compartment check of the affected limb.

  3. 03

    Assessing

    Plain X-rays - AP and lateral

    Two orthogonal views are essential. Comparison views of the opposite side are selective, not routine.

  4. 04

    Confirming

    CT for complex patterns

    Reserved for triplane fractures, Tillaux injuries and intra-articular Salter-Harris III and IV patterns where surgical planning is needed.

  5. 05

    Confirming

    MRI for occult injury

    Considered for suspected Salter-Harris V, occult physeal injury or early physeal bar assessment - specialist commissioned.

  6. 06

    Following up

    Paediatric orthopaedic referral

    All confirmed physeal fractures are managed under a specialist paediatric orthopaedic service.

  7. 07

    Following up

    Growth arrest surveillance

    Follow-up X-rays at 6 to 12 weeks and beyond, with longer term monitoring for angular deformity or limb length discrepancy.

Typical timeline: from ED presentation to a settled specialist plan within days, with growth surveillance for months.

Symptoms

What a growth plate fracture looks like.

Pain, swelling and reluctance to use the limb are the classic clues. Some patterns are subtle on the first X-ray, so clinical suspicion matters.

  • Pain over the growth plate

    Localised tenderness at the end of a long bone after a fall, twist or sports injury - classic in the wrist and ankle.

  • Swelling and bruising

    Rapid swelling and bruising around a joint in a child or adolescent should be treated as a fracture until proven otherwise.

  • Visible deformity

    Angulation or a step at the wrist, ankle or elbow suggests significant displacement and needs urgent assessment.

  • Unwillingness to use the limb

    Refusal to weight-bear or use the arm is a strong clinical clue, even when X-rays look subtle.

  • Subtle X-ray findings

    Salter-Harris I injuries can be minimally displaced with only slight widening of the physis - clinical suspicion drives the diagnosis.

  • Neurovascular concerns

    Numbness, pallor, weak pulses or pain out of keeping with the injury are red flags for compartment or nerve compromise.

  • Intra-articular pattern

    Salter-Harris III and IV cross the joint surface - anatomic reduction is essential to avoid arthritis and growth disturbance.

  • Red flag - inconsistent history

    A story that does not fit the injury, or a very young non-mobile child, triggers a safeguarding assessment.

Treatment

How growth plate fractures are treated.

Undisplaced injuries are usually cast. Displaced and intra-articular patterns need reduction and, often, surgical fixation - always under paediatric orthopaedic care.

  • Cast or splint - undisplaced

    Undisplaced Salter-Harris I and II fractures are usually managed in a well-moulded cast or splint with staged weight-bearing under specialist care.

  • Closed reduction

    Displaced physeal fractures are gently reduced under sedation or anaesthesia, with careful technique to protect the growth plate.

  • Percutaneous K-wire fixation

    Unstable Salter-Harris II fractures may be stabilised with smooth K-wires crossing the physis - see /treatments/paediatric-fracture-fixation/.

  • Open reduction and internal fixation

    Intra-articular Salter-Harris III and IV injuries need anatomic ORIF, typically with epiphyseal or metaphyseal screws that avoid the physis.

  • Triplane and Tillaux management

    Distal tibial transitional fractures need precise CT planning and specialist paediatric orthopaedic fixation to restore the joint surface.

  • Physeal bar resection

    For established growth arrest with a small central bar - see /treatments/growth-plate-bar-resection/ - to restore growth potential.

  • Guided growth and lengthening

    Angular deformity or limb length discrepancy may need guided growth, epiphysiodesis or limb lengthening - specialist commissioned.

  • MDT paediatric rehabilitation

    Structured physiotherapy - see /treatments/physio-clinic/ - alongside paediatric orthopaedic follow-up restores function and confidence.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your paediatric orthopaedic team knows your child and their imaging. If you are worried, seek review the same day.

  • British Society for Children’s Orthopaedic Surgery (BSCOS). Consensus guidance on paediatric fractures.

  • BOAST. British Orthopaedic Association Standards for the management of paediatric fractures.

  • Royal College of Paediatrics and Child Health (RCPCH). Safeguarding children and young people.

  • NICE NG76. Child abuse and neglect - recognition and response.

  • Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am.

Red flags

When a physeal injury needs urgent attention.

Most growth plate fractures do well. These are the situations that need same-day specialist input or safeguarding review.

  • Suspected non-accidental injury

    Inconsistent history, multiple injuries at different stages, or a non-mobile child with a fracture must trigger a formal safeguarding assessment.

  • Neurovascular compromise

    Pallor, absent pulses, altered sensation or worsening pain after reduction needs urgent orthopaedic review to exclude vascular injury or compartment syndrome.

  • Open fracture

    Any wound communicating with the fracture is an emergency - intravenous antibiotics, tetanus review and urgent surgical debridement in line with BOAST standards.

  • Compartment syndrome

    Pain out of proportion, pain on passive stretch and a tense compartment - especially after high-energy tibial injuries - requires immediate surgical decompression.

  • Missed Salter-Harris V

    A crush injury to the physis often looks normal on the first X-ray. Persistent pain or later deformity warrants MRI and specialist review.

  • Intra-articular displacement

    Any step or gap of more than 2 mm across the joint surface in Salter-Harris III or IV fractures needs anatomic reduction - usually surgical.

  • Growth arrest and physeal bar

    Progressive angular deformity or shortening after a physeal injury needs early referral for bar assessment and consideration of resection or guided growth.

  • Delayed presentation

    A child presenting late with pain, deformity or refusal to use a limb still deserves imaging - late fractures and growth disturbance can be missed easily.

  • Elbow injury with subtle X-ray

    Paediatric elbow anatomy is complex - a raised fat pad or malaligned ossification centre may be the only clue to a significant physeal injury.

Living with it

Healing well, with growth in mind.

Four things that make the biggest difference through recovery - cast care, staged activity, follow-up X-rays and knowing when to come back sooner.

A quiet reminder

Growth is a long-game.

Even after the cast is off, occasional follow-up X-rays over months and years pick up growth arrest early, when treatment options are widest.

  1. 01 Immobilisation

    Protect the cast or splint

    Keep it clean and dry, elevate the limb early, and watch fingers or toes for colour, warmth and movement.

  2. 02 Activity

    Follow the specialist plan

    Weight-bearing, sport and school PE are staged - your paediatric orthopaedic team will tell you when each step is safe.

  3. 03 Follow-up

    Attend the growth checks

    X-rays at 6 to 12 weeks and beyond catch growth arrest early, when treatment options are widest.

  4. 04 Warning signs

    Know when to come back sooner

    Increasing pain, numbness, pale or blue fingers or toes, or a cast that feels too tight - seek urgent review the same day.

Frequently asked

Everything parents ask about growth plate fractures.

Quick answers on Salter-Harris types, treatment choices and long-term growth.

  • What is a growth plate fracture?

    A growth plate fracture, or physeal injury, is a break involving the cartilaginous growth plate at the end of a long bone in a child or adolescent. It matters because the physis is where the bone grows in length, so injuries here can affect future growth and alignment.

  • What is the Salter-Harris classification?

    It is a five-part system used across the UK and internationally. Type I runs transversely through the physis, type II involves the physis and metaphysis with a Thurston-Holland fragment, type III crosses the physis into the epiphysis, type IV crosses physis, epiphysis and metaphysis, and type V is a crush of the physis with the highest risk of growth arrest.

  • Which growth plate is most commonly injured?

    The distal radius at the wrist is by far the most common, followed by the distal tibia and fibula at the ankle, the phalanges of the fingers, the distal humerus at the elbow and the distal femur at the knee.

  • Will my child have long-term problems?

    Most physeal fractures heal well when they are diagnosed early, reduced accurately if displaced, and followed up by a paediatric orthopaedic team. The main risks - growth arrest, angular deformity and limb length discrepancy - are highest in Salter-Harris IV and V injuries and in high-energy trauma. Structured follow-up is designed to catch these problems early.

  • Does every growth plate fracture need surgery?

    No. Many undisplaced Salter-Harris I and II fractures are managed successfully in a cast or splint. Surgery is generally reserved for unstable, displaced or intra-articular patterns - typically closed reduction with K-wires, or open reduction and internal fixation for Salter-Harris III and IV injuries.

  • When should I worry about safeguarding?

    Any fracture in a non-mobile baby, any story that does not match the injury, multiple injuries of different ages, or a delayed presentation should prompt a formal safeguarding assessment in line with RCPCH and NICE guidance. This is a routine part of paediatric fracture care and is not a judgement of the family - it is there to keep every child safe.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.