43t-E/4   Epi-/metaphyseal fractures (Salter-Harris IV) of the distal tibia

Salter-Harris IV fractures are physeal injuries that run through the metaphysis and epiphysis, involving the articular surface.

In the distal tibia, these fractures are classified as 43t-E/4.1 (simple) and 43t-E/4.2 (multifragmentary).

An associated fibular fracture may have a different configuration, may not involve the physis, and is classified separately.

There is often an associated fibular fracture or, less commonly, a lateral ligament injury.

This type of physeal fracture has a high risk of growth disturbance, malunion, and subsequent osteoarthritis. Anatomical restoration of these fractures reduces these risks.

A CT scan may be required to assess the fracture pattern and articular surface displacement.

X-rays showing a Salter-Harris IV tibial fracture with an associated simple metaphyseal fracture of the fibula in a 9-year-old patient