13-E/2.1   Simple epiphysiolysis with metaphyseal wedge, SH II

The pattern of this fracture is characterized by an epiphyseal separation with a medial or lateral metaphyseal wedge (Salter-Harris II). As the metaphyseal wedge can be very small, this fracture type is often mistakenly classified as 13-E/1.1.

This fracture occurs more often in infants and very young children in whom the capitellum is not yet ossified. Diagnosis can therefore be very difficult.

Note: Be aware of the possibility of nonaccidental injuries in younger children.

Radiologically this fracture is very difficult to diagnose and to distinguish from lateral condylar separations (13-E/4.1).

Ultrasonography is helpful in reaching a correct diagnosis.

Arthrography can also be helpful.

MRI under sedation is sometimes indicated in very young children.