Physeal fracture distal tibial - Salter-Harris I

Case contributed by Jeremy Jones


Twisted ankle while playing football. Swollen and tender. Not weight-bearing.

Patient Data

Age: 14 years
Gender: Male

Physeal fracture of the distal tibia. Lateral shift of the epiphysis relative to the metaphysis and widening of the physis anteriorly because of angulation through the fracture. No large metaphyseal or epiphyseal component. The distal fibula is normal.

6 week follow up


6 week follow up out of case. Excellent reduction. Periphyseal lucency because of disuse.

Case Discussion

Salter-Harris fractures are fractures through the physis with, or without, fracture propagation through the metaphysis or epiphysis.

In this case, there is epiphyseal shift on the metaphysis and there must be an underlying physeal fracture. There is not a visible metaphyseal or epiphyseal component and this is therefore classed as Salter-Harris type I.

In some cases, further imaging may expose a small metaphyseal component, which would make this a type II injury. CT does this on many occasions. However, that distinction does not alter management or prognosis and therefore does not bring with it a clinical benefit.

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