43t-E/2   Epiphysiolysis with metaphyseal wedge (Salter-Harris II) of the distal tibia

Salter-Harris II fractures are physeal injuries with metaphyseal extension. This metaphyseal component is known as the Thurstan Holland fragment and remains attached to the epiphysis.

In the distal tibia, these fractures are classified as 43t-E/2.1.

The position of the metaphyseal fragment depends on the mechanism of injury. It is usually located posterolaterally in external rotation injuries. In high-energy valgus injuries, the metaphyseal fragment is lateral.

An associated fibular fracture may have a different configuration and is classified separately.

Salter-Harris II fractures, with at least one other metaphyseal fragment, are classified as 43t-E/2.2.

They are often unstable and are usually associated with a fibular fracture.

The position of the metaphyseal fragment depends on the mechanism of injury.

The metaphyseal fragment may be comminuted and the metaphyseal fracture line may extend to the opposite cortex.

An associated fibular fracture is common, may have a different configuration, and is classified separately.

The Salter-Harris II fracture is the most common pattern of injury involving the distal tibial physis.

Periosteum is a common block to reduction.

A multifragmentary fracture results from high-energy trauma. Soft-tissue injuries should be anticipated, and there is a greater risk of growth disturbance.

Lateral and mortise x-ray of an isolated simple Salter-Harris II tibial fracture with a posterior metaphyseal fragment

AP and lateral x-ray of a simple Salter-Harris II tibial fracture with a lateral metaphyseal fragment combined with a fibular shaft fracture (42f-D/3.1)

X-rays showing a multifragmentary Salter-Harris II tibial fracture with an associated Salter-Harris I fracture of the fibula in a 9-year-old patient