Epiphysiolysis with metaphyseal wedge (Salter-Harris II)

Simple and multifragmentary Salter-Harris type-II fractures of the proximal tibia are classified 41t-E/2.1 and 41t-E/2.2.

Salter-Harris type-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 higher-energy injuries, metaphyseal comminution may occur. These fractures are often unstable and are usually associated with a fibular fracture. The position of the metaphyseal fragment in a simple fracture is usually located medially. In multifragmentary fractures, the fracture configuration depends on the mechanism of injury.

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

Proximal tibial physeal fractures are associated with a high incidence of growth disturbance.

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

Periosteum may block reduction.

High-energy trauma often results in a multifragmentary fracture.

Soft-tissue injuries should be anticipated, and there is a greater risk of growth disturbance.

AP and lateral x-rays should be obtained.

These x-rays show a simple Salter-Harris type-II fracture with a medial Thurstan Holland fragment in a 10-year-old patient.

These x-rays show a multifragmentary Salter-Harris type-II fracture in a 3-year-old patient.