If you have difficulty referencing theSalter-Harris classification of fractures through the physis, remember the mnemonic "ME".Hey you !! Who ME? Yeah, you, what kind of Salter-Harris fracture is that? ME stands for Metaphysis and Epiphysis. The SH-I fracture, we all know is through the physis without any involvement of the metaphysis or epiphysis. The SH-II fracture is through the metaphysis (M) and the physis. The SH-IIIfracture is through the epiphysis (E) and the physis. The SH-IV fracture is a contiguous fracture through the epiphysis, the physis, and the metaphysis (ME). The SH-V fracture is a crush injury of the physis.

An SH-I fracture may be suspected on clinical grounds alone. The fracture line may not be radiographically evident if the epiphysis is not displaced. Tenderness over the physis should lead you to suspect an occult SH-I fracture in the region of the tenderness even if the radiographs are normal. This commonly occurs in a wrist injury where normal wrist radiographs may lead one to the pitfall of diagnosing a wrist sprain. If there is tenderness over the physis of the distal radius or ulna, a clinical diagnosis of an SH-I fracture of this area should be made. An SH-I fracture is only visible radiographically if the physis is widened, distorted, or the epiphysis is displaced.Radiographic confirmation of clinical SH-I fractures may be made later during orthopedic follow-up by stress views or the presence of new bone formation along the physis approximately 7-10 days post-injury.

This radiograph shows a tiny fracture of the ulnar styloid. The AP view is otherwise unremarkable. The patient had point tenderness over the dorsum of the radial physis. The lateral view shows a displaced radial epiphysis. On careful inspection, you can see that the radial epiphysis is not centered over the metaphysis. The radial epiphysis is slightly displaced dorsally with respect to the metaphysis. No fractures of the epiphysis or the metaphysis are visible. Since the fracture is strictly through the physis, this is a Salter-Harris type I fracture.

An SH-II fracture occurs through the physis and metaphysis (M).