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To understand the pathomechanics of a physeal fracture, a basic understanding of growth plate histology is necessary. However despite multiple attempts to revise and expand on the classification of Salter and Harris, their system continues to be the most-widely used classification system of physeal injuries. In addition, he described four new types that included injury to developing bone’s other growth mechanisms (metaphyseal, diaphyseal, periosteal, zone of Ranvier, and epiphyseal perichondrium) not included in the Salter-Harris classification system. This revised classification system included subclassifications of the original five Salter-Harris patterns meant to stratify the risk of growth arrest based on injury patterns. Rang added a sixth type of physeal injury which described damage to the perichondral ring that resulted from direct open injuries. 2), various authors have expanded on the original work of Salter and Harris in attempts to be more comprehensive. Since the landmark paper by Salter and Harris, which characterized five types of physeal fractures (Fig. This zone, located in the zone of hypertrophy, represents a transitional point between calcified and noncalcified extracellular matrix proteins, making it weaker than its surrounding osseous-ligamentous structures, and therefore more susceptible to injury. They recognized that physeal fractures consistently occur through the same histologic plane called the zone of provisional calcification (Fig. Their classification focuses on injuries at pressure epiphyses. In contrast, traction epiphyses provide appositional growth, occur at the origin or insertion of muscles, are extraarticular, and do not bear weight. Pressure epiphyses provide longitudinal growth, occur at the end of long bones, are intraarticular, and bear weight. Salter and Harris described two major types of epiphyseal plates: the pressure epiphysis and the traction epiphysis. Robert Harris (1922–2005), created a physeal fracture classification system based on anatomy, fracture pattern, and prognosis.
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In 1963, two Canadian orthopaedic surgeons, Robert B. Aitken further defined the characteristics of different types of physes with respect to structure, location, weightbearing status, and susceptibility to injury, suggesting that prognosis be considered on an individual basis. In 1898, Poland classified these fractures into four types. The first detailed description of injuries involving the epiphyseal plate was in 1863 by Foucher. These fractures represent between 15% and 18% of all pediatric fractures and present diagnostic and treatment challenges for orthopaedic surgeons. Fractures involving the epiphyseal plate, or physis, are common musculoskeletal injuries occurring in children with open growth plates.