Q1 2024 Urgent Caring – 20 Questions (And Answers) About Salter Harris 1 Fracture Management

Michael Weinstock, MD & Gita Pensa, MD


  1. What is a physis?
  • This is a growth plate which separates the epiphysis (end of the bone) from the metaphysis (the area approximating the long bone).
  1. What percentage of pediatric fractures involve the growth plate?
  • 20-35%
  1. What is a Salter-Harris (SH) 1 injury?
  • It is a longitudinal fracture through the physis/growth plate which does not involve a fracture through the epiphysis or the metaphysis.
  1. Are SH 2-5 able to be managed in Urgent Care ?
  • No, these will typically need to be referred.
  1. What percent of SH injuries are type 1?
  • About 15%
  1. What is the most common SH fracture?
  • The most common SH fracture is type 2.
  1. What are historical features of an SH injury?
  • Mechanism may be an impact such as fall from a height or while running or playing, or a twisting motion, often occurring during sports.
  • There will be pain.
  • Sometimes, the inability to bear weight will be present.
  1. What are exam findings of an SH 1 injury?
  • Ecchymosis
  • Swelling
  • Pain with palpation over physis 
  • If severe, possible displacement
  1. Is an SH 1 injury easy to see on an ankle X-ray?
  • The X-ray may be normal, but can also see soft-tissue swelling, an effusion, widening of the physis or an irregular appearance of the physis.
  1. What is the DDx?
  • Strain (though ankle strains are probably SH 1 fractures)
  • Vascular compromise
  • Infection/septic joint
  • Referred pain
  1. What are the important findings to document?
  • Appearance of the skin – is there erythema, blue coloration?
  • Neuro/vascular status
  • Temperature – is the foot cold or blue?
  • Deformity
  • Palpate the proximal fibula for a Maisonneuve fracture (spiral fracture of the proximal fibula)
  • Palpate the proximal 5th metatarsal for possible Jones fracture of avulsion fracture
  1. Which other imaging tests could be done with diagnostic uncertainty and concern for more serious injury?
  • CT or MRI or stress radiographs (uncommon to do in Urgent Care, especially with SH 1 fractures)
  1. How is an SH 1 fracture managed?
  • Splint
  • Weight bearing is OK as tolerated
  1. When should the patient follow-up?
  • 7-10 days
  1. What should be done at follow-up?
  • If there is diagnostic uncertainty, repeat the X-ray and if there are signs of healing fracture, then we have confirmed the DX.
  1. Which SH fractures are most concerning?
  • SH 3 and above 
  1. How do we differentiate SH 1 from SH 5?
  • They can appear similar but consider the mechanism of injury. This will be much more severe with an SH 5.
  1. How often are there complications of a SH1 fracture?
  • They are likely less than 1% if the time.
  1. Are there SH 1 fractures that are concerning?
  • The slipped capital femoral epiphysis (SCFE) is technically an SH 1 which can lead to AVN, so it will need an accurate and rapid diagnosis.
  • Also, caution with capitellum due to the fact it could indicate a supracondylar fracture.
  1. How long should the patient be immobilized?
  • 3-4 weeks


  • Charlene Jones, Michael Wolf, Martin Herman; Acute and Chronic Growth Plate Injuries. Pediatr Rev March 2017; 38 (3): 129–138. 
  • Brown T, Moran M. Pediatric Sports-Related Injuries. Clin Pediatr (Phila). 2019;58(2):199-212. 
  • Salter R, Harris, W. Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 1963;45A:587-622

Michael B. Weinstock, MD

Emergency Medicine attending physician, Adena Health System

Director of Research, Adena Health System

Professor of Emergency Medicine, Adjunct, The Wexner Medical Center at The Ohio State University

Senior Clinical Editor, The Journal of Urgent Care Medicine (JUCM)

Medical Director, Ohio Dominican University Physician Assistant Studies Program

Michael Pallaci, DO

Core Faculty, Summa Health System

Clinical Professor of Emergency Medicine

Ohio University Heritage College of Osteopathic Medicine