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.