Synopsis
Recognise growth-plate injury even when early radiographs are subtle, restore joint and physeal alignment gently and maintain site-specific surveillance for arrest, angular deformity and limb-length discrepancy.
- Salter-Harris I stays within the physis, II exits through metaphysis, III through epiphysis, IV crosses metaphysis to epiphysis and V is compression injury.
- First-line assessment includes mechanism, remaining growth, skin, deformity, adjacent joint and documented distal pulse, perfusion, motor and sensation before and after splintage.
- First-line imaging is orthogonal radiography including the adjacent joint; normal films do not exclude a type-I injury with focal physeal tenderness.
Key red flags
Focal growth-plate tenderness after trauma can represent Salter-Harris I injury despite normal initial radiographs.
Investigation priorities
Define physis, displacement, metaphyseal and epiphyseal extension, joint alignment and associated injury.
Management branches
Trauma produces focal physeal pain, deformity, open wound or neurovascular concern.
- Use trauma assessment, give analgesia and document skin, compartments and named distal neurovascular findings.
- Cover an open wound, give indicated antibiotics and tetanus care and splint without repeated manipulation.
Type I or II injury is stable and aligned within site- and age-specific limits.
Key medicines
Paracetamol for paediatric fracture painPrescribe the current BNFC age- and weight-based dose, documenting exact milligrams, formulation volume, interval and maximum daily amount.
Intravenous morphine for severe displaced-fracture painUse the local paediatric IV titration protocol with weight-based small aliquots and continuous respiratory, sedation and oxygen-saturation monitoring during acute care.