33-E/2.2   Epiphysiolysis with metaphyseal wedge, Salter-Harris II, multifragmentary

Fractures of the distal femur with a separation of epiphysis and a metaphyseal wedge attached to the epiphyseal fragment (Salter-Harris II) and at least one other metaphyseal fragment are classified as 33-E/2.2.

The Salter-Harris II fracture is the most common pattern of injury involving the growth plate.

Children struck from the lateral side, common in sports and pedestrian injuries, often have lateral displacement of the distal fragment and valgus angulation.

Hyperextension mechanisms produce anterior displacement of the distal fragment and apex posterior angulation.

If these fractures are seen in children below walking age child abuse should be suspected.