13-E/4.2 Multifragmentary epi-/metaphyseal, Salter-Harris IV
The pattern of this fracture is similar to that in the adult (13-C1; "Y-fracture"). This fracture occurs mostly in children approaching skeletal maturity. In contrast to the adult type, which also may have an intermediate joint fragment (13-C3), usually only two articular fragments occur in children.
The classification is independent of fragment size and displacement.
More than three fragments are very unusual and rarely (if ever) reported in big case collections.
Standard AP and lateral x-rays provide a clear diagnosis in the majority of cases. If the pathoanatomy of the fracture complex is unclear, then 3D CT scans are helpful.
Traction films under anesthesia are helpful for planning implant choice and position.
Older child (older than 6 years):
This is a Y-fracture in an adolescent with two main articular fragments