An example of this isa Triplane fracture at the ankle which has the following three components: As this fracture involves the epiphysis, the articular cartilage may be damaged. This is also an intra-articular fracture, in which the fracture passes through the epiphysis, physis, and metaphysis. One example of this is a Tillaux fracture of the ankle, which is a fracture of the anterolateral aspect of the growth plate andepiphysis. Since the epiphysis is involved, damage to the articular cartilage may occur. If the fracture extends the complete length of the physis, this type of fracture may form two epiphyseal segments. This is an intra-articular fracture extending from the physis into the epiphysis. If it involves the distal end of the bone, the physis is distal to the metaphysis, so this extends proximally from the physis into the metaphysis. If the proximal end of the bone is involved, the physis is proximal to the metaphysis, so this extends distally from the physis into the metaphysis.

When the small corner of the metaphysis is visible, this is known as a corner sign or Thurston-Holland fragment.Д«e careful in using the terms proximalВ and distalВ to describe the extension, because the position of the physis is relative to the metaphysis and is not fixed. These are most common and occur away from the joint space. These are when the fracture extends through both the physis and metaphysis. An example is SlippedВ CapitalВ Femoral Epiphysis (SCFE). Diagnosis is based on clinical findings such as the presence of focal tenderness or swelling surrounding the growth plate. Look for the widening of the physis or displacement of the epiphysis, which may suggest a fracture. A radiograph may be normal due to lack of bony involvement, and mild to moderate soft tissue swelling may be noted. Beware that a normal radiograph cannot exclude a physisВ injury in a symptomatic pediatric patient. Type I fracturesВ are due to the longitudinal force applied through the physis which splits the epiphysis from the metaphysis. This is when the fracture line extends through the physis or within the growth plate. Ranging from I to V, lower numbers are less severe and have less of a propensity for growth abnormalities.

Salter-Harris fractures include a classification system that allows providers to risk stratify injuries.

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