23-E/2.1   Simple epiphysiolysis with metaphyseal wedge, Salter-Harris II, both bones

This is an uncommon combination of fractures. It is usually caused by a fall onto an outstretched hand.

These fractures are associated with local tenderness over the distal radius and ulna. Local swelling is usual. Visible deformity is often present; this is usually a posterior translation.

Note: Be aware of nonaccidental injury in infants.

X-ray shows a complete fracture, direction of displacement, and size of the metaphyseal fragments.